Healthcare Provider Details

I. General information

NPI: 1497014773
Provider Name (Legal Business Name): ABBI NICHOLE KIFER RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BISMARCK ROAD
MOUNT STORM WV
26739-0120
US

IV. Provider business mailing address

PO BOX 120
MOUNT STORM WV
26739-0120
US

V. Phone/Fax

Practice location:
  • Phone: 304-693-7696
  • Fax:
Mailing address:
  • Phone: 304-693-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number697
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDX2416
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: