| NPI | 1720384381 |
|---|---|
| Former Name | LORAN KIMBERLY CARROLL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC139) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.003277) |
| 363AS0400X Physician Assistant, Surgical (Licence: OH 50.003227) | |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2024-04-02 |