Healthcare Provider Details

I. General information

NPI: 1528987062
Provider Name (Legal Business Name): MISTY MARCHINKE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S VIRGINIA ST
RIDGELEY WV
26753-7207
US

IV. Provider business mailing address

225 S VIRGINIA ST
RIDGELEY WV
26753-7207
US

V. Phone/Fax

Practice location:
  • Phone: 304-582-2352
  • Fax:
Mailing address:
  • Phone: 304-582-2352
  • 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: