Provider Demographics
NPI:1174231781
Name:HONAKER, KEMBERLY
Entity type:Individual
Prefix:
First Name:KEMBERLY
Middle Name:
Last Name:HONAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KEM
Other - Middle Name:
Other - Last Name:HONAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2673 DAVISSON RUN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-6838
Mailing Address - Country:US
Mailing Address - Phone:681-342-3200
Mailing Address - Fax:
Practice Address - Street 1:2673 DAVISSON RUN RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-6838
Practice Address - Country:US
Practice Address - Phone:681-342-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV55803163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty