| NPI | 1508285685 |
|---|---|
| Former Name | COURTNEY MARIE CARROLL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC TL2715) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KS 15-01690) |
| 363A00000X Physician Assistant (Licence: OK 2432) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2017-05-03 |