NPI | 1043305477 |
---|---|
Former Name | JAMIE A. QUALLS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA506) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY PA506) |
Enumeration Date | 2006-10-03 |
Last Update Date | 2011-07-18 |