Individual
KELLY RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
418 MEADOWS RD, CRAIGSVILLE, WV 26205-8887
(304) 651-4220
Mailing address
418 MEADOWS RD, CRAIGSVILLE, WV 26205-8887
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
02/22/2021
Last updated
02/22/2021
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