NPI | 1053976571 |
---|---|
Former Name | SHELBY JAE COX |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA060591) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004799) |
Enumeration Date | 2019-05-09 |
Last Update Date | 2019-05-09 |