Individual
KELLY JOHNSON BUMGARNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5720 BLAZER PKWY, DUBLIN, OH 43017-3566
(614) 761-1151
Mailing address
5720 BLAZER PKWY, DUBLIN, OH 43017-3566
(614) 761-1151
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110003813
VA
Other
Enumeration date
02/08/2012
Last updated
07/16/2015
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