| NPI | 1619713583 |
|---|---|
| Former Name | KELSEY JEAN FREDRICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1157397) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1157397) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2024-07-16 |