NPI | 1548756182 |
---|---|
Former Name | KELLY LYNN LEDDY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00480700) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00480700) |
Enumeration Date | 2018-07-06 |
Last Update Date | 2025-07-27 |