Healthcare Provider Details

I. General information

NPI: 1285562405
Provider Name (Legal Business Name): RACHEAL KILLINGSWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21297 GRAHAM STATION RD
MOUNT ALTO WV
25264-9754
US

IV. Provider business mailing address

21297 GRAHAM STATION RD
MOUNT ALTO WV
25264-9754
US

V. Phone/Fax

Practice location:
  • Phone: 304-593-1092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: