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NPI Code Detail

MEDICARE: KELLI L FOURNIER MD

MEDICARE: KELLI L FOURNIER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician19925WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588652499
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI L FOURNIER MD
Provider Business Mailing Address
First Line : 3136 WEST ST
Second Line :
City : WEIRTON
State : WV
Zip : 26062-4637
Country : US
Telephone Number : 304-748-2828
Fax Number : 304-797-0002
Provider Business Practice Location Address
First Line : 3136 WEST ST
Second Line :
City : WEIRTON
State : WV
Zip : 26062-4637
Country : US
Telephone Number : 304-748-2828
Fax Number : 304-797-0002
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 01/06/2011

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Directions to “ KELLI L FOURNIER MD” Practice Location

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