| NPI | 1659703007 |
|---|---|
| Former Name | MALLORY CLAIR JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: KY PA3172) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 2969) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX PA09558) | |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2024-04-09 |