Provider Demographics
NPI:1477187581
Name:KINDER, TRACEY STUART
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:STUART
Last Name:KINDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 19TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3709
Mailing Address - Country:US
Mailing Address - Phone:304-234-3500
Mailing Address - Fax:
Practice Address - Street 1:111 19TH ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3709
Practice Address - Country:US
Practice Address - Phone:304-234-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist