| NPI | 1316585730 |
|---|---|
| Former Name | KATELYN NICOLE RICHARDS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA PA57601) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 57601) |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2023-06-27 |