Provider Demographics
NPI:1588411698
Name:SMALL, DONNA KAY
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:KAY
Last Name:SMALL
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 1:192 POCAHONTAS ST
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2362
Mailing Address - Country:US
Mailing Address - Phone:304-203-7948
Mailing Address - Fax:
Practice Address - Street 1:102 TAMARACK DR
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-1244
Practice Address - Country:US
Practice Address - Phone:304-472-5616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide