Graduated: 2025
NPI: 1386367787
Practice Locations (4)
300 DAVE COWENS DR, SUITE 600
NEWPORT, KY 410714543
PO BOX
CINCINNATI, OH 45263
1203 JOHNSTOWN RD
BECKLEY, WV 258014943
PO BOX, SUITE 1572
Oceana, WV 248701572
Source: CMS National Downloadable File, September 2026.