Provider Demographics
NPI:1073212213
Name:PREECE, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:PREECE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 STOLLINGS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25053-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 MACCORKLE AVE SE STE B-16
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1297
Practice Address - Country:US
Practice Address - Phone:304-388-5848
Practice Address - Fax:304-388-5848
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2744363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical