| NPI | 1881907533 |
|---|---|
| Former Name | KELLY LYNN RANDEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LJ0000257) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DE L10039256) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: DE LJ0000257) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP010860) | |
| Enumeration Date | 2010-07-23 |
| Last Update Date | 2011-09-15 |