| NPI | 1831270420 |
|---|---|
| Former Name | SUSAN MARY KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 205349) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX 520140) |
| 363L00000X Nurse Practitioner (Licence: TX 520140) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP106025) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TN AP106025) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2022-06-02 |