NPI | 1972218998 |
---|---|
Former Name | KATELYN RAE BIGGERSTAFF |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 5381) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
Enumeration Date | 2023-01-16 |
Last Update Date | 2024-06-17 |