NPI | 1487170718 |
---|---|
Former Name | KELLIE K WAUGH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: IA G176775) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 104780) |
Enumeration Date | 2017-08-18 |
Last Update Date | 2023-10-24 |