NPI | 1114719119 |
---|---|
Former Name | ALEXANDRA MITCHELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC067) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY TC067) |
363AS0400X Physician Assistant, Surgical (Licence: KY TC067) | |
Enumeration Date | 2025-05-19 |
Last Update Date | 2025-09-02 |