Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 53-78368-102 | KS |
NPI | 1316429228 |
---|---|
Provider Name | Kailey Michelle Fox |
First Address | Park City, KS 67147-7304 |
Second Address | Wichita, KS 67214-4910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2018 |
Last Update Date | 06/09/2018 |