Healthcare Provider Details

I. General information

NPI: 1225506975
Provider Name (Legal Business Name): MERCEDES SCHOONOVER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MERCEDES JOHNSON RN

II. Dates (important events)

Enumeration Date: 11/10/2018
Last Update Date: 11/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5296 REDBUD HWY
HONAKER VA
24260-7379
US

IV. Provider business mailing address

1802 4TH ST
RICHLANDS VA
24641-2308
US

V. Phone/Fax

Practice location:
  • Phone: 276-991-9500
  • Fax: 276-991-4399
Mailing address:
  • Phone: 304-960-9739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001238291
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176875
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: