Provider Demographics
NPI:1427126929
Name:SHUMAN, KELLY JO (MT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JO
Last Name:SHUMAN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CIMARRON RD
Mailing Address - Street 2:
Mailing Address - City:NUTTER FORT
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4374
Mailing Address - Country:US
Mailing Address - Phone:304-623-5551
Mailing Address - Fax:304-623-5552
Practice Address - Street 1:135 CIMARRON RD
Practice Address - Street 2:
Practice Address - City:NUTTER FORT
Practice Address - State:WV
Practice Address - Zip Code:26301-4374
Practice Address - Country:US
Practice Address - Phone:304-623-5551
Practice Address - Fax:304-623-5552
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2000-479174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist