| NPI | 1821106048 |
|---|---|
| Former Name | STACY LYNN KELVIE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 010820) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 010820) |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 010820) | |
| 363L00000X Nurse Practitioner (Licence: NY 10820) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2023-06-28 |