Provider Demographics
NPI:1710578026
Name:SPITZNOGLE, KANDYCE RAYLEA
Entity Type:Individual
Prefix:MS
First Name:KANDYCE
Middle Name:RAYLEA
Last Name:SPITZNOGLE
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 1:1400 JOHNSON AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1063
Mailing Address - Country:US
Mailing Address - Phone:304-842-9054
Mailing Address - Fax:
Practice Address - Street 1:4008 HILLSIDE VLG
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-9312
Practice Address - Country:US
Practice Address - Phone:304-502-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant