NPI | 1083983555 |
---|---|
Former Name | CINDY L PUCKETT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA.200619) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 015398) |
Enumeration Date | 2011-12-29 |
Last Update Date | 2018-12-14 |