Healthcare Provider Details

I. General information

NPI: 1164987574
Provider Name (Legal Business Name): MOHAMMED JAWEED FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2019
Last Update Date: 02/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 HARPER RD
BECKLEY WV
25801-3357
US

IV. Provider business mailing address

210 E ST
BECKLEY WV
25801-6504
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-4100
  • Fax:
Mailing address:
  • Phone: 304-237-7105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71609-NP-C
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: