| NPI | 1619327285 |
|---|---|
| Former Name | KIMBERLY MAYERS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA9203) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC TL2593) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2023-03-20 |