| NPI | 1679156608 |
|---|---|
| Former Name | MCKENNA COLLIER SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: UT 13768000-1206) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2024-03-12 |