| NPI | 1235957275 |
|---|---|
| Former Name | KELLIE ANTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MO 2024040280) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2019002386) |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2025-11-21 |