Healthcare Provider Details

I. General information

NPI: 1073477709
Provider Name (Legal Business Name): KENDRA NICOLE PAINTER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LAIDLEY ST
CHARLESTON WV
25301-1614
US

IV. Provider business mailing address

758 LIMESTONE RD
CHARLESTON WV
25312-6438
US

V. Phone/Fax

Practice location:
  • Phone: 304-352-2663
  • Fax: 304-414-7449
Mailing address:
  • Phone: 304-552-2288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112713
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: