Healthcare Provider Details

I. General information

NPI: 1619890589
Provider Name (Legal Business Name): KEVIN VINING
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 BIG HOLLOW RD
BEN TREE WV
25125
US

IV. Provider business mailing address

PO BOX 225
DIXIE WV
25059-0225
US

V. Phone/Fax

Practice location:
  • Phone: 740-517-6596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: