| NPI | 1326790726 |
|---|---|
| Former Name | KELLY DIAMOND |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA063356) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA005997) |
| 363A00000X Physician Assistant (Licence: DE C5-0012325) | |
| Enumeration Date | 2022-01-26 |
| Last Update Date | 2025-10-20 |