| NPI | 1639696867 |
|---|---|
| Former Name | KELLY LAKIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: VA 0024175463) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 95065961) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2022-12-19 |