Healthcare Provider Details

I. General information

NPI: 1508533571
Provider Name (Legal Business Name): KRISTEN SHAYLEE LOOMIS MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38378 MIDLAND TRL E STE B
CALDWELL WV
24925-2101
US

IV. Provider business mailing address

176 MEDICAL CENTER DR
RAINELLE WV
25962-1064
US

V. Phone/Fax

Practice location:
  • Phone: 304-520-0182
  • Fax:
Mailing address:
  • Phone: 304-438-6188
  • Fax: 304-521-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBP00946292
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberBP00946292
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: