Provider Demographics
NPI:1891977211
Name:MCMINN, KELLY B (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:B
Last Name:MCMINN
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1138
Mailing Address - Country:US
Mailing Address - Phone:304-824-5806
Mailing Address - Fax:
Practice Address - Street 1:7400 LYNN AVE
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1138
Practice Address - Country:US
Practice Address - Phone:304-824-5806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV61615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810016618Medicaid
WVNP34211Medicare Oscar/Certification
WVWV1835EMedicare Oscar/Certification
WVWV1835BMedicare Oscar/Certification
WVWV1835FMedicare Oscar/Certification
WV3810016618Medicaid
WVWV0313AMedicare Oscar/Certification
WVWV1835GMedicare Oscar/Certification
WVWV1835CMedicare Oscar/Certification
WVWV1835DMedicare Oscar/Certification
WVWV1835B662Medicare Oscar/Certification