| NPI | 1134192925 |
|---|---|
| Former Name | MARY REBECCA KELLAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MO 079829) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 45130) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2022-01-28 |