Healthcare Provider Details

I. General information

NPI: 1598594491
Provider Name (Legal Business Name): BENEDICTA AYIKPAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 09/22/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VETERANS AVE
BECKLEY WV
25801-6444
US

IV. Provider business mailing address

200 VETERANS AVE
BECKLEY WV
25801-6444
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-2121
  • Fax:
Mailing address:
  • Phone: 304-255-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number120572
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2374918
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: