Provider Demographics
NPI:1962383661
Name:CONNOLLY, HUNTER
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 ISAACS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LOST CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26385-6993
Mailing Address - Country:US
Mailing Address - Phone:681-526-2684
Mailing Address - Fax:
Practice Address - Street 1:1200 ISAACS CREEK RD
Practice Address - Street 2:
Practice Address - City:LOST CREEK
Practice Address - State:WV
Practice Address - Zip Code:26385-6993
Practice Address - Country:US
Practice Address - Phone:681-526-2684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide