Healthcare Provider Details

I. General information

NPI: 1568325405
Provider Name (Legal Business Name): KENDYL HARVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 11/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 SANDLICK BRANCH RD
BRUNO WV
25611
US

IV. Provider business mailing address

PO BOX 24
BRUNO WV
25611-0024
US

V. Phone/Fax

Practice location:
  • Phone: 304-687-0060
  • Fax:
Mailing address:
  • Phone: 304-687-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number38628
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: