NPI | 1568884930 |
---|---|
Former Name | KATELYN BLAKE BRYANT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA08819) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
363AM0700X Physician Assistant, Medical | |
Enumeration Date | 2014-01-20 |
Last Update Date | 2025-08-15 |