| NPI | 1831340801 |
|---|---|
| Former Name | KIMBERLY ANN GODBOLD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005439) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 005439) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2013-10-19 |