Healthcare Provider Details

I. General information

NPI: 1861571473
Provider Name (Legal Business Name): KIMBERLY M FARRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AMALIA DR
BUCKHANNON WV
26201-2239
US

IV. Provider business mailing address

1 AMALIA DR
BUCKHANNON WV
26201-2239
US

V. Phone/Fax

Practice location:
  • Phone: 304-473-2066
  • Fax: 304-472-0533
Mailing address:
  • Phone: 304-473-2066
  • Fax: 304-472-0533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number18623
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: