| NPI | 1326192493 |
|---|---|
| Other Name | KELLY ANNE SHORES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110003194) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110003194) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA 22892) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-06-16 |