NPI | 1124530670 |
---|---|
Former Name | AMANDA CARSON MCKINNEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX AP144247) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN APN23300) |
363LP0200X Nurse Practitioner, Pediatrics (Licence: TN APN23300) | |
Enumeration Date | 2017-10-24 |
Last Update Date | 2022-11-04 |