| NPI | 1730412172 |
|---|---|
| Former Name | KELLY SUE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL PA9114802) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA055368) |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2022-01-26 |