Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20163 | WV |
N | 207QA0401X | Family Doctor - Addiction Medicine | 20163 | WV |
NPI | 1871597716 |
---|---|
Provider Name | Dr. Chesley Yellott |
First Address | Kearneysville, WV 25430 |
Second Address | Kearneysville, WV 25430-4793 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 08/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5630482000 | (05) | WV |
B67653 | (02) | WV |