Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | E9500 | AR |
Y | 207Q00000X | Family Doctor | ME131477 | FL |
NPI | 1003227141 |
---|---|
Provider Name | Kristie Driver |
First Address | Salt Lake City, UT 84145-0443 |
Second Address | Jacksonville, FL 32210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2014 |
Last Update Date | 25/08/2021 |