Individual
MRS. KAY BOWIE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1929 MASON DIXON HIGHWAY, CORE, WV 26541
(304) 879-5020
(304) 879-4105
Mailing address
1929 MASON DIXON HIGHWAY, CORE, WV 26541
(304) 879-5020
(304) 879-4105
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
43007
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001722602
BLUE CROSS
—
05
—
7101028000
—
WV
01
—
P01268331
RAILROAD
WV
01
—
WV3681D142
MEDICARE PTAN
WV
Enumeration date
08/16/2006
Last updated
08/05/2016
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