Provider Demographics
NPI:1205560927
Name:KUYKENDALL, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:KUYKENDALL
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 1:8933 PATTERSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26710-5105
Mailing Address - Country:US
Mailing Address - Phone:681-242-1783
Mailing Address - Fax:
Practice Address - Street 1:8933 PATTERSON CREEK RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WV
Practice Address - Zip Code:26710-5105
Practice Address - Country:US
Practice Address - Phone:681-242-1783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant