| NPI | 1104229699 |
|---|---|
| Former Name | CARYN PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA1923) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KY TC294) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2022-06-22 |