Provider Demographics
NPI:1083250328
Name:ANDREWS, RAZHANE KELECCE KELECCE NICOLE
Entity Type:Individual
Prefix:
First Name:RAZHANE KELECCE
Middle Name:KELECCE NICOLE
Last Name:ANDREWS
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 1:209 19TH ST APT 15
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25703-1145
Mailing Address - Country:US
Mailing Address - Phone:304-429-9174
Mailing Address - Fax:
Practice Address - Street 1:209 19TH ST APT 15
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1145
Practice Address - Country:US
Practice Address - Phone:304-429-9174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer