Individual
KIMBERLY SUE CROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
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
Update your record
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