Provider Demographics
NPI:1144831942
Name:MCCORMICK, KAREN MAXINE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MAXINE
Last Name:MCCORMICK
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 1:2145 KELLYS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25312-6816
Mailing Address - Country:US
Mailing Address - Phone:304-382-1390
Mailing Address - Fax:
Practice Address - Street 1:2145 KELLYS CREEK RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25312-6816
Practice Address - Country:US
Practice Address - Phone:304-382-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant