Provider Demographics
NPI:1396340733
Name:RIDDLE, KELLIE DEANN
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:DEANN
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:DEANN
Other - Last Name:BIBBEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52 ONWARD BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26187-8338
Mailing Address - Country:US
Mailing Address - Phone:304-916-2739
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:1222 MARKET ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-4323
Practice Address - Country:US
Practice Address - Phone:304-865-5420
Practice Address - Fax:304-865-5423
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker