| NPI | 1245707090 |
|---|---|
| Former Name | KELLIE MCGRUE HAWTHORNE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15260) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA2072) |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2022-03-09 |