Healthcare Provider Details

I. General information

NPI: 1417679630
Provider Name (Legal Business Name): LORIE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 HANSON ST
BUCKHANNON WV
26201-8717
US

IV. Provider business mailing address

87 HANSON ST
BUCKHANNON WV
26201-8717
US

V. Phone/Fax

Practice location:
  • Phone: 304-613-6218
  • Fax:
Mailing address:
  • Phone: 304-613-6218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: