Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 17036 | WV |
N | 207P00000X | Emergency Physician | 58-003772 | OH |
NPI | 1013210822 |
---|---|
Provider Name | Dr. Kelly Anne Klocek |
First Address | Wheeling, WV 26003-5313 |
Second Address | Wheeling, WV 26003-3823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2010 |
Last Update Date | 16/12/2010 |