| NPI | 1356102669 |
|---|---|
| Former Name | KALISSIA BENNETT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5019980) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 28682) |
| 163W00000X Registered Nurse (Licence: NC 158967) | |
| Enumeration Date | 2024-01-23 |
| Last Update Date | 2025-09-08 |