| NPI | 1629238787 |
|---|---|
| Former Name | KELLIE NICOLE GOFORTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: VA 0101249447) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX Q3465) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2026-04-03 |