Individual
KATELYNN STICKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
111 S GROVE ST, PETERSBURG, WV 26847-1804
(304) 257-2451
(304) 257-1263
Mailing address
PO BOX 97, BAKER, WV 26801-0097
(304) 897-5915
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2500
WV
208M00000X
Hospitalist Physician
2500
WV
363A00000X
Physician Assistant
2500
WV
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
05/19/2021
Last updated
02/25/2025
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