| NPI | 1447815857 |
|---|---|
| Former Name | KELLY MCCORMICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: KY 3012670) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3012670) |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2023-08-16 |