NPI | 1154809622 |
---|---|
Former Name | KRISTIN BOUNDS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3615) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110006306) |
363A00000X Physician Assistant (Licence: NC 0010-08196) | |
Enumeration Date | 2018-08-06 |
Last Update Date | 2019-04-03 |