| 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 |