Individual
KIMBERLY SUE CROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
800 PENNSYLVANIA AVE, CHARLESTON, WV 25302-3351
(304) 388-2526
(304) 388-2537
Mailing address
800 PENNSYLVANIA AVE, CHILDREN'S MEDICINE CENTER, CHARLESTON, WV 25302
(304) 388-2525
(304) 388-2537
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
19689
WV
208000000X
Pediatrics Physician
Primary
19689
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001721334
MS BCBS
WV
05
—
3002030000
—
WV
01
—
7354454
AETNA
WV
Enumeration date
07/07/2005
Last updated
07/05/2019
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