Basic Information
| Provider Information | |||||||||
| NPI: | 1821510793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEARTH | ||||||||
| FirstName: | KAYLA | ||||||||
| MiddleName: | O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 WYNDEMERE WAY | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261052276 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 314 S WELLS ST | ||||||||
| Address2: | |||||||||
| City: | SISTERSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261751098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046522611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2017 | ||||||||
| LastUpdateDate: | 04/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 3337 | WV | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 3337 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.