| NPI | 1255701157 |
|---|---|
| Former Name | MICHELLE KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA10117) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2021-06-28 |