Healthcare Provider Details

I. General information

NPI: 1164374872
Provider Name (Legal Business Name): KELLEY R KYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 SAND MINE RD
BERKELEY SPRINGS WV
25411-7457
US

IV. Provider business mailing address

106 SAND MINE RD
BERKELEY SPRINGS WV
25411-7457
US

V. Phone/Fax

Practice location:
  • Phone: 304-258-3096
  • Fax:
Mailing address:
  • Phone: 304-258-3096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: