NPI | 1972154185 |
---|---|
Former Name | KARLEE CAMPBELL BRADBERRY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA1099) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 3137) |
Enumeration Date | 2019-09-28 |
Last Update Date | 2023-01-23 |