Provider Demographics
NPI:1033088083
Name:ABE, KELLIE DAWN
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:DAWN
Last Name:ABE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HIDEAWAY LN
Mailing Address - Street 2:
Mailing Address - City:FORT ASHBY
Mailing Address - State:WV
Mailing Address - Zip Code:26719-6972
Mailing Address - Country:US
Mailing Address - Phone:301-707-7276
Mailing Address - Fax:
Practice Address - Street 1:114 HIDEAWAY LN
Practice Address - Street 2:
Practice Address - City:FORT ASHBY
Practice Address - State:WV
Practice Address - Zip Code:26719-6972
Practice Address - Country:US
Practice Address - Phone:301-707-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-29
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR204449163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management