Healthcare Provider Details

I. General information

NPI: 1801480926
Provider Name (Legal Business Name): DEBRA MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MYERS RD
CAMDEN ON GAULEY WV
26208-8703
US

IV. Provider business mailing address

340 MYERS RD
CAMDEN ON GAULEY WV
26208-8703
US

V. Phone/Fax

Practice location:
  • Phone: 304-226-0584
  • Fax:
Mailing address:
  • Phone:
  • 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: