Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 13506-NP | OH |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 3007555 | KY |
NPI | 1003151150 |
---|---|
Provider Name | Kevin Wolfe |
First Address | Ashland, KY 41105-2379 |
Second Address | Portsmouth, OH 45662-2845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2012 |
Last Update Date | 26/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0083552 | (05) | OH |
3810025857 | (05) | WV |
7100241090 | (05) | KY |