| NPI | 1184976441 | 
|---|---|
| Former Name | KELLY DUVALL | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5005865) | 
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5005865) | 
| Enumeration Date | 2012-10-11 | 
| Last Update Date | 2016-08-09 |