Basic Information
| Provider Information | |||||||||
| NPI: | 1780228262 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOLFORD | ||||||||
| FirstName: | KELSEY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 IRVIN ST | ||||||||
| Address2: | |||||||||
| City: | WYTHEVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243821217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762390195 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2617 SHEFFIELD DR | ||||||||
| Address2: | |||||||||
| City: | BLACKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240608271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409532210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2019 | ||||||||
| LastUpdateDate: | 12/31/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/31/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.