Provider Demographics
NPI:1487332110
Name:KUMMER, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:KUMMER
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 1:1420 DELRAY HEIGHTS CIR
Mailing Address - Street 2:
Mailing Address - City:DELRAY
Mailing Address - State:WV
Mailing Address - Zip Code:26714-4585
Mailing Address - Country:US
Mailing Address - Phone:304-359-8881
Mailing Address - Fax:
Practice Address - Street 1:1420 DELRAY HEIGHTS CIR
Practice Address - Street 2:
Practice Address - City:DELRAY
Practice Address - State:WV
Practice Address - Zip Code:26714-4585
Practice Address - Country:US
Practice Address - Phone:304-359-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker