Susan Rennae Kirkendall, MS,AADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

98-302 Issued in WV

Practice address

527 Medical Park Dr
Bridgeport, WV 26330-9008

Phone

(304) 933-3884

NPI assigned

Sep 28, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1760967400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 ANDREW DR",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265086842",
            "telephone_number": "304-290-6533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 MEDICAL PARK DR",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263309008",
            "telephone_number": "304-933-3884"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1288 Suncrest Drive",
            "address_purpose": "LOCATION",
            "city": "Morgantown",
            "state": "WV",
            "postal_code": "265082650",
            "country_code": "US",
            "telephone_number": "304-933-3884",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIRKENDALL",
        "first_name": "SUSAN",
        "middle_name": "RENNAE",
        "name_prefix": "Ms.",
        "credential": "MS,AADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-28",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WV",
            "license": "98-302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Richard Wade King, M.D.
• Mara Alexis Kirkpatrick
• Padraig Kirkwood
• Courtney Danielle Kisamore, LGSW
• Christina Kitsos, M.D.
• Eleni Kitsos, M.D.

• Addiction (Substance Use Disorder) Counselor in Bridgeport, WV
• Providers in Bridgeport, WV by specialty
• Addiction (Substance Use Disorder) Counselor in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.