| NPI | 1710379086 |
|---|---|
| Former Name | JACKIE T PRICE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NY 018462) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: NY 018462) |
| Enumeration Date | 2015-02-24 |
| Last Update Date | 2017-10-18 |