| NPI | 1912554932 |
|---|---|
| Former Name | KELLY CUNNINGHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0008408) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085007707) |
| Enumeration Date | 2019-08-23 |
| Last Update Date | 2026-03-10 |