Provider Demographics
NPI:1790770949
Name:GILLESPIE, KARA DODRILL (PAC)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:DODRILL
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:DODRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:SCARBRO
Mailing Address - State:WV
Mailing Address - Zip Code:25917-0337
Mailing Address - Country:US
Mailing Address - Phone:304-465-1378
Mailing Address - Fax:304-469-2981
Practice Address - Street 1:601 JONES AVE
Practice Address - Street 2:COLLINS MIDDLE SCHOOL WELLNESS CENTER
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2015
Practice Address - Country:US
Practice Address - Phone:304-469-4875
Practice Address - Fax:304-469-8036
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV864363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006151Medicaid
WVPA27084Medicare PIN
WV2029895Medicare PIN
WV2029894Medicare PIN