NPI | 1376191502 |
---|---|
Former Name | KERI DANIELLE VICTORY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AR 223953) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MS 888661) |
Enumeration Date | 2019-08-30 |
Last Update Date | 2024-02-12 |