Most Relevant Information
Provider Data
| NPI Number: | 1003586520 |
| Provider Name: | KATLYN WILLIS |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/16/2021 |
| Last Updated: | 09/16/2021 |
Provider Practice Location
1100 9TH ST STE D
VIENNA
WV
261052176
Practice Location Phone/Fax
| Phone: | 3044286148 |
| Fax: |
Provider Mailing Location
1100 9TH ST STE D
VIENNA
WV
261052176
Provider Mailing Phone/Fax
| Phone: | 3044286148 |
| Fax: |