NPI 1639100266 · live from the CMS NPI Registry
Kristine K Agnew, P.A.C.
Physician Assistant, Surgical in South Charleston, WV. National Provider Identifier 1639100266, active.
NPI record
| NPI | 1639100266 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant, Surgical 363AS0400X |
| Practice location | 4607 Maccorkle Ave Sw Ste 206, South Charleston, WV 25309 |
| Practice phone | 304-766-1133 |
| Mailing address | 4605 Maccorkle Ave Sw, South Charleston, WV 25309 |
| Enumerated | July 5, 2006 |
| Last updated | August 18, 2021 |
| Sole proprietor | No |
| Other names | Kristine Mccue |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant, Medical | 363AM0700X | 412 (WV) |
| Physician Assistant, Surgical primary | 363AS0400X | 412 (WV) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.