Individual
LAUREN MCKISSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
161 BAKERS RIDGE RD, MORGANTOWN, WV 26508-1459
(304) 285-0692
Mailing address
161 BAKERS RIDGE ROAD, MORGANTOWN, WV 26508
(304) 285-0692
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
C2064
WV
Other
Enumeration date
04/14/2016
Last updated
04/14/2016
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