| 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 |