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General NPI Number Information
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NPI Number | 1265371975
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Entity Type | Individual
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Provider Name | KENLEY TRACE MIDKIFF RN
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Gender | Female
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Dates
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Enumeration Date | 03/27/2026
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Last Update Date | 03/27/2026
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Provider Practice Location Address
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Address Line | 1320 MAPLEWOOD AVE
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City | RONCEVERTE
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State | WV
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Zip | 24970-8016
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Country | US
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Telephone | 304-647-1144
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Fax |
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Provider Business Mailing Address
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Address Line | 7150 CRAG RD
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City | MEADOW BRIDGE
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State | WV
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Zip | 25976-7065
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Country | US
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Telephone | 304-667-3147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 116286
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License Number State | WV
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