| NPI | 1639489727 |
|---|---|
| Former Name | KELLI KAYE WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA21159) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA21159) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2021-04-19 |