| NPI | 1235600537 |
|---|---|
| Former Name | KIMBERLY PAIGE BOSTICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2018-12-12 |
| Last Update Date | 2022-07-21 |