| NPI | 1215568548 |
|---|---|
| Former Name | KELLY BATES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009852) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601009852) |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2026-03-18 |