NPI | 1659798056 |
---|---|
Former Name | KENDRA LYNN REILLY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA3610) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KY PA3610) |
363AS0400X Physician Assistant, Surgical (Licence: TN 5575) | |
363AS0400X Physician Assistant, Surgical (Licence: KY PA3610) | |
Enumeration Date | 2014-03-24 |
Last Update Date | 2025-07-01 |