NPI | 1982295309 |
---|---|
Former Name | KIMBERLYNN GABRIELLE THOMAS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MO 2022032222) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: KS 15-02669) |
Enumeration Date | 2021-01-28 |
Last Update Date | 2024-12-19 |