Provider Demographics
NPI:1972609550
Name:KNELL, ANTHONY B (PA)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:B
Last Name:KNELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 POPLAR ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1473
Mailing Address - Country:US
Mailing Address - Phone:304-768-4567
Mailing Address - Fax:
Practice Address - Street 1:500 POPLAR ST STE 301
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1473
Practice Address - Country:US
Practice Address - Phone:304-768-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV376-T363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical