NPI | 1770799124 |
---|---|
Former Name | KELLY LEE EVANS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.138436) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 44125) |
207QS0010X Family Medicine, Sports Medicine (Licence: KY 44125) | |
207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.138436) | |
Enumeration Date | 2007-05-15 |
Last Update Date | 2020-11-04 |