Individual
KRISTINE K AGNEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C.
Contact information
Practice address
4607 MACCORKLE AVE SW STE 206, SOUTH CHARLESTON, WV 25309-1364
(304) 766-1133
(304) 766-1136
Mailing address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 414-4800
(304) 414-4801
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
412
WV
363AS0400X
Surgical Physician Assistant
Primary
412
WV
Other
Enumeration date
07/05/2006
Last updated
08/18/2021
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