Healthcare Provider Details

I. General information

NPI: 1710211198
Provider Name (Legal Business Name): JOY DALE NUGENT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 FRONT STREET PRIMARY CARE CENTER, ST 2
MT MORRIS PA
15349-0495
US

IV. Provider business mailing address

150 MEMORIAL DR ST 2
KINGWOOD WV
26537-1141
US

V. Phone/Fax

Practice location:
  • Phone: 724-324-9001
  • Fax: 724-324-9005
Mailing address:
  • Phone: 304-329-1400
  • Fax: 304-329-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP005598B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: