Provider Demographics
NPI:1679686943
Name:WELLMAN, KATHRYN L (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:WELLMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-0176
Mailing Address - Country:US
Mailing Address - Phone:304-792-7130
Mailing Address - Fax:304-792-7148
Practice Address - Street 1:ROUTE 52
Practice Address - Street 2:VARNEY MEDICAL CENTER
Practice Address - City:VARNEY
Practice Address - State:WV
Practice Address - Zip Code:25696
Practice Address - Country:US
Practice Address - Phone:304-426-8113
Practice Address - Fax:304-426-8102
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV56173363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner