| NPI | 1295843167 |
|---|---|
| Former Name | KELLY I ROSCOE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: LA AP05822) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 2646) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-09-27 |