| NPI | 1689457749 |
|---|---|
| Former Name | KORI MICHELLE LACKEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 338473) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2023-09-06 |