Basic Information
| Provider Information | |||||||||
| NPI: | 1588055362 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WADE | ||||||||
| FirstName: | KADARA | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 280 | ||||||||
| Address2: | |||||||||
| City: | CABIN CREEK | ||||||||
| State: | WV | ||||||||
| PostalCode: | 250350280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043441623 | ||||||||
| FaxNumber: | 3043445853 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 HIDDEN BROOK WAY | ||||||||
| Address2: | |||||||||
| City: | CULLODEN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255109190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043905709 | ||||||||
| FaxNumber: | 3047431994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2015 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APRN71888-NP-C | WV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | APRN71888 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.