| NPI | 1487622205 |
|---|---|
| Former Name | KELLY R MCMAHAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0002078) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085-003885) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2021-11-29 |