Provider Demographics
NPI:1902418296
Name:BRAGG, KIRSTEN JO
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:JO
Last Name:BRAGG
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 1:155 TIMBER CRK
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-9613
Mailing Address - Country:US
Mailing Address - Phone:304-661-2756
Mailing Address - Fax:
Practice Address - Street 1:155 TIMBER CRK
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813-9613
Practice Address - Country:US
Practice Address - Phone:304-661-2756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant