Individual
KIANA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
909 MORGANTOWN AVE, FAIRMONT, WV 26554-4335
(681) 758-1907
Mailing address
909 MORGANTOWN AVE, FAIRMONT, WV 26554-4335
(681) 758-1907
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/04/2022
Last updated
11/21/2022
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