| NPI | 1275833212 |
|---|---|
| Former Name | KELLY J YDE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 0004045) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085004616) |
| 363AM0700X Physician Assistant, Medical (Licence: AZ 4748) | |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2017-11-01 |