Healthcare Provider Details

I. General information

NPI: 1497503767
Provider Name (Legal Business Name): KIMBERLY DAWN STAFFORD MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 W. TURKEY DIP RD.
OCEANA WV
24870
US

IV. Provider business mailing address

PO BOX 171
OCEANA WV
24870-0171
US

V. Phone/Fax

Practice location:
  • Phone: 304-890-8910
  • Fax:
Mailing address:
  • Phone: 304-890-8910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberAP00941456
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: