| NPI | 1225397672 |
|---|---|
| Former Name | TRACIE MCKINLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 4636) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA07788) |
| Enumeration Date | 2012-05-04 |
| Last Update Date | 2019-01-04 |