| NPI | 1205217890 |
|---|---|
| Former Name | KELSEY KOEPPEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 11085884-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 11085884-1206) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2023-11-27 |