| NPI | 1225525017 |
|---|---|
| Former Name | KENDRA MARIE KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 308091) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 69028) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2022-04-27 |