Healthcare Provider Details

I. General information

NPI: 1437429362
Provider Name (Legal Business Name): PEGGY JANE HUFFMAN RN MSN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3771 ROBERT C BYRD DR BOX 1307
BECKLEY WV
25801-2945
US

IV. Provider business mailing address

1310 OVERLOOK DR
BECKLEY WV
25801-9239
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-5710
  • Fax: 304-255-5702
Mailing address:
  • Phone: 304-256-3854
  • Fax: 304-255-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number69062
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: