Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Kiesha Marie Bullough, PA-C

Individual provider Physician Assistant · NPI 1700113412

Kiesha Marie Bullough, PA-C is a Physician Assistant in Clarksburg, West Virginia. Qualified in 2009, 17 years ago. Practices with West Virginia University Medical Corporation, a 1,981-clinician group, accepts Medicare assignment and offers telehealth. Licensed in West Virginia.

Years since qualifying
17
Licensed in
WV
In the registry since
2009
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

700 Oakmound Rd
Clarksburg, WV 26301-9398
Phone: (304) 623-6330
Fax: (304) 623-6220
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 01444 (WV)

Record details

NPI number1700113412
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedNovember 17, 2009
Last updated in NPPESJune 17, 2016

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice West Virginia University Medical Corporation — 1981 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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