| NPI | 1811352909 |
|---|---|
| Former Name | KAITLYN ANN NELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TX PA10298) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2025-05-07 |