NPI | 1619419876 |
---|---|
Former Name | JESSICA REGINA ADAMS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 9116741) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA11694) |
363A00000X Physician Assistant (Licence: NM PA2021-0083) | |
Enumeration Date | 2016-11-04 |
Last Update Date | 2023-02-02 |