Provider Demographics
NPI:1891398889
Name:KESSEL, SHIRLEY MAE
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:MAE
Last Name:KESSEL
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 1:1611 AUTUMN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26833-8565
Mailing Address - Country:US
Mailing Address - Phone:304-749-7913
Mailing Address - Fax:
Practice Address - Street 1:1611 AUTUMN VIEW RD
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26833-8565
Practice Address - Country:US
Practice Address - Phone:304-749-7913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant