Healthcare Provider Details

I. General information

NPI: 1386900140
Provider Name (Legal Business Name): ELIZABETH ANN COFFMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10003 WEBSTER RD
CAMDEN ON GAULEY WV
26208
US

IV. Provider business mailing address

415 MAIN ST
SUMMERSVILLE WV
26651-1343
US

V. Phone/Fax

Practice location:
  • Phone: 304-226-5725
  • Fax: 304-226-3274
Mailing address:
  • Phone: 304-872-1663
  • Fax: 304-226-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number64640
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: