Individual
KYLIE JO UPDEGRAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
4881 DALLAS PIKE, TRIADELPHIA, WV 26059-3797
(304) 280-4277
Mailing address
4881 DALLAS PIKE, TRIADELPHIA, WV 26059-3797
(304) 280-4277
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
73832
WV
363LF0000X
Family Nurse Practitioner
Primary
2018087323
WV
Other
Enumeration date
09/03/2019
Last updated
09/03/2019
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