Healthcare Provider Details

I. General information

NPI: 1750686374
Provider Name (Legal Business Name): KATHERINE PAULINE KITCHEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE PAULINE KINDER PA

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 5TH AVE
HUNTINGTON WV
25702-1435
US

IV. Provider business mailing address

3075 US ROUTE 60
HUNTINGTON WV
25705-8859
US

V. Phone/Fax

Practice location:
  • Phone: 304-399-7182
  • Fax: 304-523-7738
Mailing address:
  • Phone: 304-528-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01542
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: