Provider Demographics
NPI:1639811516
Name:STONEBRAKER, KATHY L
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:L
Last Name:STONEBRAKER
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 1:380 N GRAFTON ST
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-1437
Mailing Address - Country:US
Mailing Address - Phone:681-589-1089
Mailing Address - Fax:
Practice Address - Street 1:380 N GRAFTON ST
Practice Address - Street 2:
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757-1437
Practice Address - Country:US
Practice Address - Phone:681-589-1089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant