| NPI | 1760958169 |
|---|---|
| Former Name | KAYLA NICOLE WANDRICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 12007) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX TEMPORARY) |
| 363A00000X Physician Assistant (Licence: TX PA12402) | |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2024-04-25 |