Individual
DR. AGNES A ENRICO-SIMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2420 JEFFERSON AVE, PT PLEASANT, WV 25550-1528
(304) 675-6817
(304) 675-5893
Mailing address
2420 JEFFERSON AVE, PT PLEASANT, WV 25550-1528
(304) 675-6817
(304) 675-5893
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20514
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001723700
BCBS
WV
05
—
2362269
—
OH
05
—
3002914000
—
WV
01
—
7133291
AETNA
WV
Enumeration date
09/12/2006
Last updated
02/19/2024
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