Healthcare Provider Details

I. General information

NPI: 1427861822
Provider Name (Legal Business Name): ALYCIA KENNEDY-MCLEOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 2ND AVE
CHARLESTON WV
25387-2514
US

IV. Provider business mailing address

PO BOX 20112
CHARLESTON WV
25362-1112
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-0586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: