| NPI | 1235488131 |
|---|---|
| Former Name | KEISHIA HENDERSON MCCOY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP07067) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA RN117999) |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2017-03-29 |