Individual
MR. KEVIN SANSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1340 HAL GREER BLVD, HUNTINGTON, WV 25701-3804
(304) 399-6727
(304) 399-6726
Mailing address
1303 PETER CAVE RD, GENOA, WV 25517-7732
(304) 633-1940
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2996
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0013276
—
OH
05
—
1780385112
—
WV
05
—
7100886040
—
KY
Enumeration date
03/13/2023
Last updated
04/14/2023
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