Healthcare Provider Details

I. General information

NPI: 1649110842
Provider Name (Legal Business Name): NATASHA BURDETTE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 RIVER STREET
POCA WV
25159
US

IV. Provider business mailing address

176 RIVER STREET
POCA WV
25159
US

V. Phone/Fax

Practice location:
  • Phone: 681-424-4025
  • Fax:
Mailing address:
  • Phone: 681-424-4025
  • 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: