Provider Demographics
NPI:1215736467
Name:PRYOR, KAITLIN NICOLE
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:NICOLE
Last Name:PRYOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 STAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5055
Mailing Address - Country:US
Mailing Address - Phone:304-494-3304
Mailing Address - Fax:
Practice Address - Street 1:425 JULIANA ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5352
Practice Address - Country:US
Practice Address - Phone:304-893-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician