| NPI | 1316345564 |
|---|---|
| Former Name | KELLY CHARMAY ROBERTS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209011599) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209011599) |
| Enumeration Date | 2014-12-19 |
| Last Update Date | 2020-06-29 |