Healthcare Provider Details

I. General information

NPI: 1811801988
Provider Name (Legal Business Name): MICHAEL FITZWATER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 DAWSON DR
BECKLEY WV
25801-8955
US

IV. Provider business mailing address

134 DAWSON DR
BECKLEY WV
25801-8955
US

V. Phone/Fax

Practice location:
  • Phone: 681-368-1544
  • Fax:
Mailing address:
  • Phone: 681-368-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: