| NPI | 1457975088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA ASHWORTH Credentialing Specialist 304-429-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QM0801X |
| 261QP2300X Clinic/Center, Primary Care | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2023-11-17 |