Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1999-1318 | WV |
NPI | 1053518399 |
---|---|
Provider Name | Ms. Kelly Jean Fry |
First Address | Spencer, WV 25276 |
Second Address | Spencer, WV 25276 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 08/07/2007 |