Fred Salem Cornell III
Individual provider Active NPI Personal Care Attendant · Kenova, WV
NPI 1487264248 · NPPES record last updated Aug 6, 2020
Key facts
- NPI
- 1487264248
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Personal Care Attendant 3747P1801X
- Practice address
- 820 Poplar St
Kenova, WV 25530-1530 - Phone
- (304) 453-4992
- NPI assigned
- Aug 6, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | Yes |
Addresses
Primary practice location
820 Poplar St
Kenova, WV 25530-1530
Mailing address
820 Poplar St
Kenova, WV 25530-1530
Phone (304) 453-4992
Other providers in Kenova, WV
- Contemplations Behavioral Health
- Kristin C Cooper
- Stephen Shaun Cooper
- Betty June Copley
- Joseph Edward Corey II
- William Counts
- April Cox
- Claudette Cox
- William Cox
- Summer Breann Coyle
All providers in Kenova, WV · Personal Care Attendant in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.