Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 107722 | WV |
NPI | 1326636978 |
---|---|
Provider Name | Kelsey Anne Nicholes |
First Address | Wheeling, WV 26003-9717 |
Second Address | Wheeling, WV 26003-6300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2021 |
Last Update Date | 08/01/2021 |