Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | WV 3838 | WV |
Y | 213EG0000X | General Practice | WV 3838 | WV |
NPI | 1003068396 |
---|---|
Provider Name | Chandra Knotts |
First Address | Davis, WV 26260-0217 |
Second Address | Davis, WV 26260-0217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2008 |
Last Update Date | 17/10/2008 |