Healthcare Provider Details

I. General information

NPI: 1376844654
Provider Name (Legal Business Name): KELLY ANN ROBINSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY ANN DEARTH PA-C

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 EOFF ST 604
WHEELING WV
26003-3823
US

IV. Provider business mailing address

109 MOUNT WOOD RD
WHEELING WV
26003-2632
US

V. Phone/Fax

Practice location:
  • Phone: 304-234-8188
  • Fax: 304-234-8494
Mailing address:
  • Phone: 304-233-2455
  • Fax: 304-233-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number518
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: