| NPI | 1376891267 |
|---|---|
| Former Name | KETHIA MOULTRIE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN204948) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA 204948) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2019-12-12 |