Healthcare Provider Details

I. General information

NPI: 1699190181
Provider Name (Legal Business Name): HEATHER LEIGH MAYVILLE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 PEYTON ST
BARBOURSVILLE WV
25504-2063
US

IV. Provider business mailing address

3075 US ROUTE 60
HUNTINGTON WV
25705-8859
US

V. Phone/Fax

Practice location:
  • Phone: 304-697-2035
  • Fax: 304-697-1641
Mailing address:
  • Phone: 304-528-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number64634
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: