Provider Demographics
NPI:1801510250
Name:KIRKPATRICK, NICOLE AUTUMN
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:AUTUMN
Last Name:KIRKPATRICK
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 1:722 ANTHEM RD
Mailing Address - Street 2:
Mailing Address - City:WILEYVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26581-7831
Mailing Address - Country:US
Mailing Address - Phone:304-775-1940
Mailing Address - Fax:
Practice Address - Street 1:722 ANTHEM RD
Practice Address - Street 2:
Practice Address - City:WILEYVILLE
Practice Address - State:WV
Practice Address - Zip Code:26581-7831
Practice Address - Country:US
Practice Address - Phone:304-775-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1256607394Medicaid
WV1821206228Medicaid
WV125553494Medicaid