| NPI | 1790182368 |
|---|---|
| Former Name | KELLY LEIGH PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: WY 38354.1542) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH 16847) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: OK 214685) | |
| Enumeration Date | 2014-11-26 |
| Last Update Date | 2023-09-15 |