Provider Demographics
NPI:1134988926
Name:ZICKAFOOSE, KRISTIN ELIZABETH (LPN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:ZICKAFOOSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:SANFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12424 BACKUS MTN
Mailing Address - Street 2:
Mailing Address - City:MEADOW BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:25976-5680
Mailing Address - Country:US
Mailing Address - Phone:304-661-7433
Mailing Address - Fax:
Practice Address - Street 1:12424 BACKUS MTN
Practice Address - Street 2:
Practice Address - City:MEADOW BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:25976-5680
Practice Address - Country:US
Practice Address - Phone:304-661-7433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33403164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse