Individual
KELLIE FAYE GAUTIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1468 RITTER DR, DANIELS, WV 25832-9356
(304) 253-3860
Mailing address
330 CEDARCREST DR, SHADY SPRING, WV 25918-8541
(304) 890-8987
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
73240
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810021842
—
WV
Enumeration date
09/19/2011
Last updated
07/17/2024
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