Provider Demographics
NPI:1720036817
Name:HARVEY, KATHY DIANN (DO)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:DIANN
Last Name:HARVEY
Suffix:
Gender:F
Credentials:DO
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 1736
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-1736
Mailing Address - Country:US
Mailing Address - Phone:304-831-1643
Mailing Address - Fax:304-831-1646
Practice Address - Street 1:20 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3452
Practice Address - Country:US
Practice Address - Phone:304-831-1643
Practice Address - Fax:304-831-1646
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1299207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0077928000Medicaid
WV0077928000Medicaid
0696722Medicare ID - Type Unspecified