PRIMARY CARE AT HOME OF WEST VIRGINIA, LLC (NPI# 1386163392) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386163392 |
| Entity Type | Organization |
| Organization Name | PRIMARY CARE AT HOME OF WEST VIRGINIA, LLC |
| Other Organization Name | PRIMARY CARE AT HOME OF CHARLESTON |
| Practice Address |
414 Greenway Ave Ste 201 Charleston WV 25309-1475 |
| Mailing Address |
Po Box 51266 Lafayette LA 70505-1266 |
| Practice Telephone | 3043561356 |
| Practice Fax Number | 3048857475 |
| Mailing Telephone | 3372331307 |
| Mailing Fax Number | 3372335764 |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2017-09-12 |
| Authorized Official Name | DONALD D. STELLY (PRESIDENT) |
| Authorized Official Telephone | 3372331307 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Primary Care at Home of Charleston | Doing Business As Name - Organization |
| Street Address |
414 GREENWAY AVE STE 201 |
| City | CHARLESTON |
| State | WV |
| Zip Code | 25309-1475 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699376905 | Lovie Bradshaw | Technician | 4823 Tennessee St., South Charleston, WV 25309 | 2020-11-03 |
| 1306447735 | Barbara Mackenzie | Technician | 4224 Kanawha Turnpike, South Charleston, WV 25309 | 2020-11-03 |
| 1548861974 | Sarah Nichols | Technician | 4990 Colonial Park Dr. Apt. F, South Charleston, WV 25309 | 2020-11-03 |
| 1629690177 | Jennifer Mabry-goins | Technician | 4505 River Avenue, S Charleston, WV 25309 | 2020-05-07 |
| 1811537715 | Brandon C Dean | Psychologist | 4857 Macorkle Ave. Sw, South Charleston, WV 25309 | 2020-01-09 |
| 1467096057 | Linda Mullins | Technician | 60 Hayvon Lane, South Charleston, WV 25309 | 2019-11-06 |
| 1831743616 | Ann Myriah Beck | Nurse Practitioner | 4610 Maccorkle Ave Sw # 300, South Charleston, WV 25309 | 2019-07-30 |
| 1942671227 | Edward W Eskew | Family Medicine | 4605 Maccorkle Avenue, Sw, Thspp-psychiatry, South Charleston, WV 25309 | 2015-10-13 |
| 1720468218 | Link Investments LLC | Pharmacy | 5151 Macorkle Avenue, South Charleston, WV 25309 | 2015-06-01 |
| 1366840951 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 304 Southbridge Blvd., S.ccharleston, WV 25309 | 2014-12-12 |
| Find all providers in zip 25309 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043842230 | Lisa Ann Hahl | Nurse Practitioner | 30 Courtenay Drive Room 217, Msc 592, Charleston, SC 29425-8911 | 2020-02-06 |
| 1497394290 | Allison Smith | Nurse Practitioner | 1001 Centre Way, Charleston, WV 25309-9427 | 2019-12-27 |
| 1770129553 | Elizabeth Ashley Halicki | Nurse Practitioner | 96 Jonathan Lucas St Ste 420, Charleston, SC 29425-8900 | 2019-11-26 |
| 1144784919 | Danielle Alyssa Paquette | Nurse Practitioner | 30 Courtenay Dr Suite 282 Msc 295, Charleston, SC 29425-0001 | 2019-01-25 |
| 1649752791 | Ashley Catherine Waybright | Nurse Practitioner | 3100 Maccorkle Ave Se Ste 904, Charleston, WV 25304-1234 | 2018-09-05 |
| 1679069090 | Jessica Ueda | Nurse Practitioner | 310 35th St Se Ste 11, Charleston, WV 25304-1352 | 2018-07-09 |
| 1215440169 | Christine Michelle Delcioppo | Nurse Practitioner | 2085 Henry Tecklenburg Dr Fl 2or2, Charleston, SC 29414 | 2017-11-14 |
| 1962913038 | Kasey Brown | Nurse Practitioner | 830 Pennsylvania Ave Ste 110, Charleston, WV 25302-3389 | 2017-10-17 |
| 1841700440 | Laura Cunnings | Nurse Practitioner | 202 Georgetown Pl, Charleston, WV 25314-1866 | 2017-10-09 |
| 1588186886 | Caroline B Mitchell | Nurse Practitioner | 27 Gamecock Ave Ste 201, Charleston, SC 29407-3398 | 2017-07-10 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 25309 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.