| NPI | 1720858269 |
|---|---|
| Former Name | AMBER KAITLIN LOCKLEAR |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CT 6483) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CT 6483) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2024-01-05 |
| Last Update Date | 2024-03-15 |