Provider Demographics
NPI:1942457338
Name:KROLL, COLLEEN M (APRN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:KROLL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:YARBERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 9214
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9214
Mailing Address - Country:US
Mailing Address - Phone:304-293-6307
Mailing Address - Fax:304-293-1216
Practice Address - Street 1:6040 UNIVERSITY TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2421
Practice Address - Country:US
Practice Address - Phone:304-285-7222
Practice Address - Fax:304-285-7383
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WV82672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid