Individual
KIMBERLY ANN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1 MEDICAL CENTER DRIVE, MORGANTOWN, WV 26506
(304) 598-4000
Mailing address
1 MEDICAL CENTER DRIVE, MORGANTOWN, WV 26506
(304) 598-4000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
74136
WV
Other
Enumeration date
12/20/2012
Last updated
12/20/2012
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