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Individual
KELLY LEAH GLICK
Active
Individual
KELLY LEAH GLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0507
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452926
—
ND
05
—
71219
—
ND
Enumeration date
10/31/2012
Last updated
03/15/2017
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