| NPI | 1164151288 |
|---|---|
| Former Name | GRACE THOMPSON BYRUM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 5019) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-12338) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2024-12-26 |