Healthcare Provider Details

I. General information

NPI: 1265361588
Provider Name (Legal Business Name): KATIE PRITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 SCOTTS LAKE RD
BEVERLY WV
26253-8973
US

IV. Provider business mailing address

1508 SCOTTS LAKE RD
BEVERLY WV
26253-8973
US

V. Phone/Fax

Practice location:
  • Phone: 304-642-8423
  • Fax:
Mailing address:
  • Phone: 304-642-8423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: