Healthcare Provider Details

I. General information

NPI: 1376324558
Provider Name (Legal Business Name): KRISTIE MARIE ENGLISH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BANK STREET
MAYSEL WV
25133
US

IV. Provider business mailing address

PO BOX 835
CLAY WV
25043-0835
US

V. Phone/Fax

Practice location:
  • Phone: 304-587-9992
  • Fax:
Mailing address:
  • Phone: 304-587-9992
  • 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: