| NPI | 1609034453 |
|---|---|
| Former Name | MISTY BANKNELL HANEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005333) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 005333) |
| 363AS0400X Physician Assistant, Surgical (Licence: GA 005333) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2015-03-11 |