1992106132 NPI number — MRS. JACQUELYN MARIE CUNNINGHAM PA-C

Table of content: MRS. JACQUELYN MARIE CUNNINGHAM PA-C (NPI 1992106132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992106132 NPI number — MRS. JACQUELYN MARIE CUNNINGHAM PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUNNINGHAM
Provider First Name:
JACQUELYN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
JACQUELYN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992106132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 923
Provider Second Line Business Mailing Address:
ONE MEDICAL CENTER DR.
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-293-8266
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE MEDICAL CENTER DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-293-8266
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1119183 . This is a "NCCPA CERTIFICATION NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com