Individual
KENNETH S GILLESPIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
75 AVENUE B, RICHWOOD, WV 26261-1236
(304) 846-2573
(304) 846-4657
Mailing address
PO BOX 96, BEAVER, WV 25813-0096
(304) 763-5167
(304) 763-4062
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2474-23
WI
363A00000X
Physician Assistant
Primary
979
WV
Other
Enumeration date
05/24/2006
Last updated
11/22/2021
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