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General NPI Number Information
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NPI Number | 1568026243
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Entity Type | Individual
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Provider Name | NINA PAVLIVNA KANDYBA FNP-BC, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 04/27/2019
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Last Update Date | 08/26/2024
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Provider Practice Location Address
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Address Line | 4020 US ROUTE 60
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City | HUNTINGTON
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State | WV
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Zip | 25705-2944
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Country | US
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Telephone | 304-525-7851
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Fax | 304-525-1073
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Provider Business Mailing Address
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Address Line | 99 CRACKER BARREL DR STE 100
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City | BARBOURSVILLE
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State | WV
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Zip | 25504-1650
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Country | US
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Telephone |
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Fax | 304-525-1073
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3013294
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 103189
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License Number State | WV
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