NPI | 1114493889 |
---|---|
Former Name | MARY ALEXIS PRICKETT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113188) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-10-19 |
Last Update Date | 2024-07-16 |