Healthcare Provider Details

I. General information

NPI: 1912836701
Provider Name (Legal Business Name): KIMBERLY SUE GOUGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 19TH ST
WHEELING WV
26003-3715
US

IV. Provider business mailing address

570 NATIONAL RD
WHEELING WV
26003-6528
US

V. Phone/Fax

Practice location:
  • Phone: 304-234-3500
  • Fax: 304-845-9977
Mailing address:
  • Phone: 304-234-3500
  • Fax: 304-845-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number66487
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: