| NPI | 1326576026 |
|---|---|
| Former Name | KELLY SOUDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 7082) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 6095) |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2025-07-22 |