Healthcare Provider Details

I. General information

NPI: 1790400836
Provider Name (Legal Business Name): KATHY A SHRIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BRISCOE RUN RD
PARKERSBURG WV
26104-0002
US

IV. Provider business mailing address

3901 BRISCOE RUN RD
PARKERSBURG WV
26104-0002
US

V. Phone/Fax

Practice location:
  • Phone: 304-422-0776
  • Fax:
Mailing address:
  • Phone: 304-422-0776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: