Provider Demographics
NPI:1295380046
Name:MUSSELWHITE, KATHRYN A (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:MUSSELWHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:A
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1247 SUNCREST TOWN CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1876
Mailing Address - Country:US
Mailing Address - Phone:304-599-8000
Mailing Address - Fax:304-599-8003
Practice Address - Street 1:414 GRAND PARK DR STE 1
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-4065
Practice Address - Country:US
Practice Address - Phone:304-599-8000
Practice Address - Fax:304-599-8003
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22082363LP0200X
WV113710363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics