Healthcare Provider Details

I. General information

NPI: 1215095518
Provider Name (Legal Business Name): KIMBERLY KAY SANDERS CRN FIRST ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. KIMBERLY KAY KIGER

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUNCREST TOWNE CENTRE SUITE 310
MORGANTOWN WV
26505-1872
US

IV. Provider business mailing address

600 SUNCREST TOWNE CENTRE SUITE 310
MORGANTOWN WV
26505-1872
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-2200
  • Fax: 504-599-2674
Mailing address:
  • Phone: 304-598-2200
  • Fax: 504-599-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number40474
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: