Kenneth Earl Gwinn Jr., FNP-C
Nurse Practitioner, Family in Rainelle, WV. Individual provider (NPI-1).
NPI number1003417023
StatusActive
Last updated in NPPESNov 5, 2020
Details
- NPI
- 1003417023
- Entity type
- Individual (NPI-1)
- Name
- Kenneth Earl Gwinn Jr.
- Credential
- FNP-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 5, 2020
- Certification date
- Oct 11, 2020
- Last updated
- Nov 5, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 107635 | WV | Yes |
Practice location
176 Medical Center DrRainelle, WV 25962-1064
Phone 304-438-6188
Mailing address
176 Medical Center DrRainelle, WV 25962-1064
Phone 304-438-6188
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