Individual
KATHLEEN WIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
500 CHERRY ST, BLUEFIELD, WV 24701-3306
(304) 332-7110
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4342
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
15161WV
WV
207R00000X
Internal Medicine Physician
Primary
15161WV
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000023444
BLUE CROSS BLUE SHIELD
WV
05
—
0071366000
—
WV
05
—
010275598
—
VA
01
—
3001599
BRICKSTREET
WV
Enumeration date
05/16/2006
Last updated
02/17/2009
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