Individual
MRS. KIMBERLY ELAINE CONNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, CLE
Contact information
Practice address
110 SIMS CIRCLE, TRIADELPHIA, WV 26059-1154
(304) 599-8000
(304) 599-8003
Mailing address
1247 SUNCREST TOWN CENTRE DR, MORGANTOWN, WV 26505-1876
(304) 599-8000
(304) 599-8003
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
L-41918
—
363A00000X
Physician Assistant
Primary
349
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018811
—
OH
05
—
1174827893
—
WV
Enumeration date
01/10/2011
Last updated
02/04/2021
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