NPI | 1497219398 |
---|---|
Former Name | KELLY GODBEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-02349) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2020025180) |
Enumeration Date | 2019-01-24 |
Last Update Date | 2023-08-11 |