Kennerly Surgical PLLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

2239-0413 Issued in WV

Legal business name

KENNERLY SURGICAL PLLC

Practice address

809 Willow LN
PT Pleasant, WV 25550-2018

Phone

(304) 521-2230

NPI assigned

Apr 30, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

R Michael Kennerly, MD

Title

MD

Phone

(304) 521-2230

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272585600000",
    "number": "1548587496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 WILLOW LN",
            "city": "PT PLEASANT",
            "state": "WV",
            "postal_code": "255502018",
            "telephone_number": "304-521-2230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 WILLOW LN",
            "city": "PT PLEASANT",
            "state": "WV",
            "postal_code": "255502018",
            "telephone_number": "304-521-2230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNERLY SURGICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-30",
        "last_updated": "2010-04-30",
        "status": "A",
        "authorized_official_last_name": "KENNERLY",
        "authorized_official_first_name": "R",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "304-521-2230",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "WV",
            "license": "2239-0413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachelle A Hill, CFNP
• Monte Hoffman
• Robert M Holley, MD
• Ismael Ortego Jamora, MD
• John F. Wiltz PLLC
• Erin Kirk, M.A., ED.S
• Nancy Beth Lares, MD
• Mason County Action Group Inc
• Mason County Action Group Inc
• Mason County Action Group Inc.

• Surgery Physician in PT Pleasant, WV
• Providers in PT Pleasant, WV by specialty
• Surgery Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.