| NPI | 1538462619 |
|---|---|
| Former Name | KELLY TANNER TEEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA07013) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 363AM0700X Physician Assistant, Medical (Licence: TX PA07013) | |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2015-08-24 |