Provider Demographics
NPI:1306696984
Name:KPOR, CECELIA K (HEALTH CARE MANAGER)
Entity type:Individual
Prefix:MS
First Name:CECELIA
Middle Name:K
Last Name:KPOR
Suffix:
Gender:F
Credentials:HEALTH CARE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-0212
Mailing Address - Country:US
Mailing Address - Phone:304-283-0522
Mailing Address - Fax:
Practice Address - Street 1:113 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-1547
Practice Address - Country:US
Practice Address - Phone:304-283-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
WV251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care