Healthcare Provider Details

I. General information

NPI: 1851936629
Provider Name (Legal Business Name): REBECCA LYNE RATLIFF NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 02/27/2021
Certification Date: 02/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 GEORGE ST
BECKLEY WV
25801-2607
US

IV. Provider business mailing address

121 GEORGE ST
BECKLEY WV
25801-2607
US

V. Phone/Fax

Practice location:
  • Phone: 304-250-0382
  • Fax: 304-250-0382
Mailing address:
  • Phone: 304-250-0382
  • Fax: 304-250-0382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number104796
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number104796
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: