Healthcare Provider Details

I. General information

NPI: 1275494601
Provider Name (Legal Business Name): MS. KENNEDY C ROOP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MAPLE FORK RD
MOUNT HOPE WV
25880-9378
US

IV. Provider business mailing address

950 MAPLE FORK RD
MOUNT HOPE WV
25880-9378
US

V. Phone/Fax

Practice location:
  • Phone: 304-575-1834
  • Fax:
Mailing address:
  • Phone: 304-575-1834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: