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Individual

KOREY BLAKE MITCHELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
71 WAYNE ST, FORT GAY, WV 25514-8518
(304) 648-5544
(304) 648-5989
Mailing address
PO BOX 1680, HUNTINGTON, WV 25717-1680
(304) 697-1396
(304) 697-2086

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25693
WV
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0104755
OH
05
3810027586
WV
05
7100303880
KY
Enumeration date
05/19/2011
Last updated
11/13/2020
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