Healthcare Provider Details

I. General information

NPI: 1043150220
Provider Name (Legal Business Name): KIMBERLY WHITE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 JASMINE ROAD
BRUNO WV
25611
US

IV. Provider business mailing address

PO BOX 25
BRUNO WV
25611-0025
US

V. Phone/Fax

Practice location:
  • Phone: 304-946-3780
  • 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: