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NPI Code Detail

MEDICARE: MR. JOSEPH TYLER NESBITT FNP

MEDICARE: MR. JOSEPH TYLER NESBITT FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner125587WV
2163W00000XRegistered Nurse97370WV

General Provider Information

NPI Number : 1043163967
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JOSEPH TYLER NESBITT FNP
Provider Business Mailing Address
First Line : 4605 MACCORKLE AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1311
Country : US
Telephone Number : 304-766-3600
Fax Number :
Provider Business Practice Location Address
First Line : 4605 MACCORKLE AVE SW
Second Line :
City : SOUTH CHARLESTON
State : WV
Zip : 25309-1311
Country : US
Telephone Number : 304-766-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2026
Last Update Date : 03/17/2026

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