MEDICARE: KYLEN WHIPP MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	28107	WV
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1104272566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLEN WHIPP MD

Provider Business Mailing Address
First Line	:	3948 TEAYS VALLEY RD STE 2625
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-8728
Country	:	US
Telephone Number	:	304-760-1397
Fax Number	:

Provider Business Practice Location Address
First Line	:	3948 TEAYS VALLEY RD STE 2625
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-8728
Country	:	US
Telephone Number	:	304-760-1397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2016
Last Update Date	:	04/08/2026

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