Provider Demographics
NPI:1679929251
Name:KANAWHA CHARLESTON HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:KANAWHA CHARLESTON HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-348-8080
Mailing Address - Street 1:108 LEE ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1506
Mailing Address - Country:US
Mailing Address - Phone:304-348-8080
Mailing Address - Fax:304-346-4756
Practice Address - Street 1:108 LEE ST E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1506
Practice Address - Country:US
Practice Address - Phone:304-348-8080
Practice Address - Fax:304-346-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2083P0901X
251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty