NPI | 1366978470 |
---|---|
Former Name | KINSLEY MARIE COWART |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 8361) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2017-05-10 |
Last Update Date | 2022-03-10 |