Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 29732 | WV |
N | 207QS0010X | Family Doctor - Sports Medicine | 29732 | WV |
NPI | 1285169565 |
---|---|
Provider Name | Kasey Stickler |
First Address | Huntington, WV 25701-3656 |
Second Address | Huntington, WV 25701-3656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2017 |
Last Update Date | 23/11/2021 |