Healthcare Provider Details

I. General information

NPI: 1942573522
Provider Name (Legal Business Name): YOSELY KATHY CRUZ-FERNANDEZ ACNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 HARPER RD
BECKLEY WV
25801-3397
US

IV. Provider business mailing address

1157 DRY HILL RD
BECKLEY WV
25801-2109
US

V. Phone/Fax

Practice location:
  • Phone: 559-260-7911
  • Fax:
Mailing address:
  • Phone: 559-260-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN88151
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704232812
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN88151
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: