| NPI | 1972600393 |
|---|---|
| Former Name | KIMBERLY RENEE CRUMBLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4808) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA ap1949) |
| 363A00000X Physician Assistant (Licence: VA 0110001947) | |
| 363A00000X Physician Assistant (Licence: LA PA.200347) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-03-07 |