Individual
MRS. KELLY NICOLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1307 LAFAYETTE AVE, MOUNDSVILLE, WV 26041-2316
(304) 845-2500
(304) 845-2624
Mailing address
1307 LAFAYETTE AVE, MOUNDSVILLE, WV 26041-2316
(304) 845-2500
(304) 845-2624
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
222
WV
Other
Enumeration date
10/21/2005
Last updated
11/27/2018
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