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General NPI Number Information
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NPI Number | 1174827893
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Entity Type | Individual
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Provider Name | KIMBERLY ELAINE CONNOR PA-C, CLE
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Gender | Female
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 110 SIMS CIRCLE
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City | TRIADELPHIA
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State | WV
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Zip | 26059-1154
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Country | US
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Telephone | 304-599-8000
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Fax | 304-599-8003
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Provider Business Mailing Address
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Address Line | 1247 SUNCREST TOWN CENTRE DR
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City | MORGANTOWN
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State | WV
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Zip | 26505-1876
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Country | US
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Telephone | 304-599-8000
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Fax | 304-599-8003
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-41918
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 349
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License Number State | WV
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