Individual
KELLY JO HAZUKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
100 AVERY OLIVIA WAY STE B, FAIRMONT, WV 26554-9375
(304) 333-1650
(304) 333-1651
Mailing address
100 AVERY OLIVIA WAY STE C, FAIRMONT, WV 26554-9375
(304) 363-7000
(304) 366-7413
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
58344
WV
Other
Enumeration date
10/14/2012
Last updated
10/05/2017
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