| NPI | 1780143297 |
|---|---|
| Former Name | KAITLYN ANNE KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 25512) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: TN APN25512) |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2021-02-04 |