| NPI | 1679847560 |
|---|---|
| Former Name | KELSEY MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CO PA.0004227) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA4364) |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2018-10-23 |