Provider Demographics
NPI:1982443206
Name:BUTCHER, KASSIDY CHRISTINA
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:CHRISTINA
Last Name:BUTCHER
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 1:68 DAYS RUN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:26570-8512
Mailing Address - Country:US
Mailing Address - Phone:304-276-3880
Mailing Address - Fax:
Practice Address - Street 1:100 B & O BLVD
Practice Address - Street 2:
Practice Address - City:PENTRESS
Practice Address - State:WV
Practice Address - Zip Code:26544
Practice Address - Country:US
Practice Address - Phone:304-376-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide