| NPI | 1174718738 |
|---|---|
| Former Name | KELLY BLAKE RYDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 002185) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CT 002185) |
| 363A00000X Physician Assistant (Licence: CT 002185) | |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2020-07-01 |