Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 0102205885 | VA |
NPI | 1043709066 |
---|---|
Provider Name | Kelley Marie Sonney |
First Address | Jbsa Lackland, TX 78236-5638 |
Second Address | Fort Sam Houston, TX 78234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2018 |
Last Update Date | 10/05/2020 |