Individual
MRS. KELLY EVERETT HEMPHILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5293
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01357356
AMERIGROUP
GA
01
—
587186
WELLCARE
GA
05
—
742533948A
—
GA
05
—
742533948B
—
GA
Enumeration date
04/08/2008
Last updated
12/12/2024
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