NPI | 1770357048 |
---|---|
Former Name | BRIANNA MARIE TIPTON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NC 0010-13762) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-13762) |
363AM0700X Physician Assistant Medical (Licence: NC 0010-13762) | |
Enumeration Date | 2023-11-08 |
Last Update Date | 2023-11-08 |