| NPI | 1568884930 |
|---|---|
| Former Name | KATELYN BLAKE BRYANT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2014-01-20 |
| Last Update Date | 2015-02-23 |