| NPI | 1962801647 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY PA2506) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: KY PA2506) |
| 363AM0700X Physician Assistant Medical (Licence: SC 2153) | |
| 363AS0400X Physician Assistant Surgical (Licence: KY PA2506) | |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2025-08-15 |