Provider Demographics
NPI:1649055146
Name:KINSEY, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:KINSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 FRITZ CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1890
Mailing Address - Country:US
Mailing Address - Phone:304-692-3420
Mailing Address - Fax:
Practice Address - Street 1:1007 FRITZ CIR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1890
Practice Address - Country:US
Practice Address - Phone:304-692-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker