| NPI | 1043280241 |
|---|---|
| Former Name | KELLY PARKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 202004545) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 047988) |
| 207Q00000X Family Medicine (Licence: FL ME140393) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2021-02-01 |