Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AL5042 | FL |
Y | 213ES0000X | Sports Medicine | AL5042 | FL |
NPI | 1336654011 |
---|---|
Provider Name | Krista Mcauley |
First Address | Albuquerque, NM 87106-4006 |
Second Address | West Palm Beach, FL 33401-6505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2017 |
Last Update Date | 04/12/2017 |