| NPI | 1558691444 |
|---|---|
| Former Name | KELLY COLLEEN DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209008235) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 18191) |
| Enumeration Date | 2009-12-28 |
| Last Update Date | 2015-04-20 |