Healthcare Provider Details

I. General information

NPI: 1922922210
Provider Name (Legal Business Name): KIMBERLY MCCORMICK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2941 POINT LICK DR
CHARLESTON WV
25306
US

IV. Provider business mailing address

2941 POINT LICK DR
CHARLESTON WV
25306
US

V. Phone/Fax

Practice location:
  • Phone: 304-590-4827
  • Fax:
Mailing address:
  • Phone: 304-590-4827
  • 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: