Provider Demographics
NPI:1578206140
Name:TOLER, KELLIE RENA
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:RENA
Last Name:TOLER
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 1:581 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WELCH
Mailing Address - State:WV
Mailing Address - Zip Code:24801-2101
Mailing Address - Country:US
Mailing Address - Phone:304-809-1779
Mailing Address - Fax:
Practice Address - Street 1:581 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WELCH
Practice Address - State:WV
Practice Address - Zip Code:24801-2101
Practice Address - Country:US
Practice Address - Phone:304-809-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant