Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 94 | TN |
NPI | 1063046274 |
---|---|
Provider Name | Kyndall Mccall Proffitt |
First Address | Trenton, GA 30752-4118 |
Second Address | Trenton, GA 30752-4118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2020 |
Last Update Date | 26/02/2020 |