NPI | 1114476611 |
---|---|
Former Name | KARISSA CARPENTER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002164A) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9115876) |
Enumeration Date | 2016-09-25 |
Last Update Date | 2025-05-15 |