Healthcare Provider Details

I. General information

NPI: 1508726654
Provider Name (Legal Business Name): KLPNP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 DOCTORS DR
BRIDGEPORT WV
26330-1721
US

IV. Provider business mailing address

104 DOCTORS DR
BRIDGEPORT WV
26330-1721
US

V. Phone/Fax

Practice location:
  • Phone: 240-624-6694
  • Fax: 833-340-2409
Mailing address:
  • Phone: 240-624-6694
  • Fax: 833-340-2409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: KAYLA DOLLY
Title or Position: OWNER
Credential: APRN
Phone: 304-709-2471