Individual
MR. JERRY A. QUISENBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
471 MAIN ST, MADISON, WV 25130-1223
(304) 369-5170
(304) 369-0946
Mailing address
7400 LYNN AVE, HAMLIN, WV 25523-1138
(304) 824-5806
(304) 824-5885
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
867
WV
Other
Enumeration date
06/12/2006
Last updated
02/12/2018
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