Courtney Desiree Pack
Individual provider Active NPI Personal Care Attendant · Kermit, WV
NPI 1619735685 · NPPES record last updated Mar 13, 2024
Key facts
- NPI
- 1619735685
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Personal Care Attendant 3747P1801X
- Practice address
- 1378 Left Fork Marrowbone CRK
Kermit, WV 25674-7275 - Phone
- (304) 733-1094
- NPI assigned
- Mar 13, 2024
- Sex
- Female
- 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
1378 Left Fork Marrowbone CRK
Kermit, WV 25674-7275
Mailing address
1378 Left Fork Marrowbone CRK
Kermit, WV 25674-7275
Other providers in Kermit, WV
- Lark Justin Muncy
- Josephine Newsome
- Lucretia Lynn Newsome
- Ruth Newsome
- Santana Ashby Newsome
- Tammy Rachelle Pennington
- Selena Rose Perry
- Song Ye Perry
- Janet Preece
- Jamie Rebecca Price
All providers in Kermit, 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 Mar 13, 2024. 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.