Provider Demographics
NPI:1275135360
Name:KRISHOCK, KAITLIN ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:ELIZABETH
Last Name:KRISHOCK
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 1:443 SANFORD ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-6548
Mailing Address - Country:US
Mailing Address - Phone:304-282-2772
Mailing Address - Fax:
Practice Address - Street 1:350 CAPITOL ST # 427
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1757
Practice Address - Country:US
Practice Address - Phone:304-558-5388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
WV1-21-51933174400000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No174400000XOther Service ProvidersSpecialist