| NPI | 1881447696 |
|---|---|
| Former Name | JESSICA CAITLIN WILLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: KY 4023701) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: KY 1152126) |
| Enumeration Date | 2024-04-10 |
| Last Update Date | 2024-07-22 |