MEDICARE: MRS. SARAH D FENNEY FNP-BC

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
1	363LF0000X	Family Nurse Practitioner	105137	WV

General Provider Information

NPI Number	:	1366075012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH D FENNEY FNP-BC

Provider Business Mailing Address
First Line	:	2959 3RD AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25702-1401
Country	:	US
Telephone Number	:	304-781-3588
Fax Number	:

Provider Business Practice Location Address
First Line	:	2959 3RD AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25702-1401
Country	:	US
Telephone Number	:	304-781-3588
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	02/20/2020

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