Bullough, Kiesha Marie

Bullough, Kiesha Marie is an individual health care provider with primary practice located at 700 Oakmound Rd , Clarksburg WV 26301-9398. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Bullough, Kiesha Marie can be contacted via phone (304) 623-6330.

Contact Information

Primary practice address
700 Oakmound Rd Clarksburg WV 26301-9398
Phone: (304) 623-6330
Fax: (304) 623-6220
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 01444 West Virginia

Profile Details

NPI number 1700113412
LBN Legal business name Bullough, Kiesha Marie
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2009
Last updated Jun 17th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700113412 NPPES
West Virginia MEDICAID 3810016314

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