Healthcare Provider Details

I. General information

NPI: 1164817763
Provider Name (Legal Business Name): RURAL ACRES INFUSION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 RURAL ACRES DR
BECKLEY WV
25801-3579
US

IV. Provider business mailing address

117 RURAL ACRES DR
BECKLEY WV
25801-3579
US

V. Phone/Fax

Practice location:
  • Phone: 304-860-1446
  • Fax: 304-894-8513
Mailing address:
  • Phone: 304-860-1446
  • Fax: 304-894-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN49209-FNP-BC
License Number StateWV

VIII. Authorized Official

Name: AUTUMN D. SMITH
Title or Position: OWNER
Credential:
Phone: 304-860-1446