Provider Demographics
NPI:1407415417
Name:KIMMELL, NATASHA E
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:E
Last Name:KIMMELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:E
Other - Last Name:SPOOLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-3520
Mailing Address - Country:US
Mailing Address - Phone:304-788-1113
Mailing Address - Fax:
Practice Address - Street 1:130 CENTER ST
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-3520
Practice Address - Country:US
Practice Address - Phone:304-788-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health