| NPI | 1801816079 |
|---|---|
| Former Name | KELLY BRANDON MCDONALD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101054649) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101054649) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2019-06-27 |