| NPI | 1386796662 |
|---|---|
| Former Name | KIMBERLY DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601007425) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA056757) |
| 363A00000X Physician Assistant (Licence: OH 50-002531) | |
| 363A00000X Physician Assistant (Licence: WI 2390-23) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2018-03-29 |