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General NPI Number Information
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NPI Number | 1760386155
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Entity Type | Organization
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Legal Business Name | K-VA-T FOOD STORES INC
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 11501 HARDIN VALLEY RD
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City | KNOXVILLE
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State | TN
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Zip | 37932-1423
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Country | US
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Telephone | 865-692-5183
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Fax | 865-692-5223
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Provider Business Mailing Address
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Address Line | PO BOX 1158
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City | ABINGDON
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State | VA
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Zip | 24212-1158
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Country | US
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Telephone | 276-623-5100
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Fax | 276-623-5440
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | SUZANNE NICOLE 'NIKKI' NIDIFFER
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Credential |
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Telephone | 276-623-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | NULL
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