Provider Demographics
NPI:1215655188
Name:PAUGH, KISTA
Entity type:Individual
Prefix:
First Name:KISTA
Middle Name:
Last Name:PAUGH
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 1:1550 LUDWICK ST APT 17
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-2040
Mailing Address - Country:US
Mailing Address - Phone:304-790-4064
Mailing Address - Fax:
Practice Address - Street 1:1550 LUDWICK ST APT 17
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-2040
Practice Address - Country:US
Practice Address - Phone:304-790-4064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant