| NPI | 1215267349 |
|---|---|
| Former Name | TAMMY RAYE BOYETTE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA PA54682) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: VA 0110003655) |
| 363AM0700X Physician Assistant Medical (Licence: FL PA9107316) | |
| 363AM0700X Physician Assistant Medical (Licence: NC 0010-02138) | |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2018-10-26 |