Basic Information
| Provider Information | |||||||||
| NPI: | 1760858401 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRABISH | ||||||||
| FirstName: | KERRY | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 70 | ||||||||
| Address2: | |||||||||
| City: | DAWES | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250540070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047342040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 107 KOONTZ AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | CLENDENIN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250459581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045487272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2015 | ||||||||
| LastUpdateDate: | 07/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN63237FNP-BC | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1760858401 | 05 | WV | MEDICAID |