| NPI | 1780031625 |
|---|---|
| Former Name | KELLY ANN CAMPBELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: FL pa112573) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 26641) |
| 363A00000X Physician Assistant (Licence: FL 9112573) | |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2020-08-26 |