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Individual
KELLIE DEANNE TATRO
Active
Individual
KELLIE DEANNE TATRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, RRA, RT(R)
Taxonomy
Speciality
Code
Description
License number
State
243U00000X
Radiology Practitioner Assistant
349813
—
363A00000X
Physician Assistant
Primary
301411
NC
363A00000X
Physician Assistant
C0010339
MD
Other
Enumeration date
04/11/2019
Last updated
04/09/2026
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