Provider Demographics
NPI:1205290178
Name:RITTENHOUSE, KIMBERLY J (PMHNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:RITTENHOUSE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 DUPONT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-9704
Mailing Address - Country:US
Mailing Address - Phone:304-917-3521
Mailing Address - Fax:304-917-3522
Practice Address - Street 1:1809 DUPONT RD STE 1
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101
Practice Address - Country:US
Practice Address - Phone:304-917-3521
Practice Address - Fax:304-917-3522
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN82164363L00000X
WV2016002933363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty