MEDICARE: KENDRA NICOLE PAINTER FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	112713	WV

General Provider Information

NPI Number	:	1073477709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA NICOLE PAINTER FNP-C

Provider Business Mailing Address
First Line	:	758 LIMESTONE RD
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25312-6438
Country	:	US
Telephone Number	:	304-552-2288
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 LAIDLEY ST
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1614
Country	:	US
Telephone Number	:	304-352-2663
Fax Number	:	304-414-7449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2025
Last Update Date	:	12/16/2025

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