Healthcare Provider Details

I. General information

NPI: 1902219223
Provider Name (Legal Business Name): DR. MARY ANN KUYKENDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 BEVERLY PIKE
ELKINS WV
26241-9475
US

IV. Provider business mailing address

690 BEVERLY PIKE
ELKINS WV
26241-9475
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-7349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0008214
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202212416
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: