| NPI | 1649388935 |
|---|---|
| Former Name | KELLY BURGESS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 01632) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 011430) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2012-09-07 |