| NPI | 1912520875 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5105) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: KY TC128) |
| 363A00000X Physician Assistant (Licence: KY PA2921) | |
| 363AM0700X Physician Assistant Medical | |
| 363AM0700X Physician Assistant Medical (Licence: KY TC128) | |
| 363AM0700X Physician Assistant Medical (Licence: KY PA2921) | |
| 363AS0400X Physician Assistant Surgical (Licence: KY PA2921) | |
| 363AS0400X Physician Assistant Surgical (Licence: KY TC128) | |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2023-04-18 |