Healthcare Provider Details

I. General information

NPI: 1104879311
Provider Name (Legal Business Name): KELLEE E. ABNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 MACCORKLE AVE SW
SOUTH CHARLESTON WV
25309-1311
US

IV. Provider business mailing address

331 LAIDLEY ST SUITE 606
CHARLESTON WV
25301-1619
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-0096
  • Fax: 304-342-4725
Mailing address:
  • Phone: 304-344-0096
  • Fax: 340-342-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number19280
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: