Provider Demographics
NPI:1437328259
Name:VERZICH, KATHRYN
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:
Last Name:VERZICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 78 BOX 96A
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WV
Mailing Address - Zip Code:26814-9709
Mailing Address - Country:US
Mailing Address - Phone:304-567-3164
Mailing Address - Fax:
Practice Address - Street 1:204 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-1628
Practice Address - Country:US
Practice Address - Phone:304-257-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24587163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0013079000Medicaid