Provider Demographics
NPI:1609047109
Name:DUNAVANT, KELLY W (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:W
Last Name:DUNAVANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:597 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:WV
Mailing Address - Zip Code:26451-6801
Mailing Address - Country:US
Mailing Address - Phone:304-745-4568
Mailing Address - Fax:304-326-3700
Practice Address - Street 1:597 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WEST MILFORD
Practice Address - State:WV
Practice Address - Zip Code:26451-6801
Practice Address - Country:US
Practice Address - Phone:304-745-4568
Practice Address - Fax:304-326-3700
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV2195207Q00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2195OtherWV MEDICAL LICENSE