NPI | 1376058024 |
---|---|
Former Name | KERRI MICHELE SMITH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-07725) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-07725) |
Enumeration Date | 2017-12-04 |
Last Update Date | 2021-03-29 |