Healthcare Provider Details

I. General information

NPI: 1679465587
Provider Name (Legal Business Name): MICHAELA RYANNE GEORGE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 MACCORKLE AVE SE
CHARLESTON WV
25304-1334
US

IV. Provider business mailing address

107 VERNA DR
ELKVIEW WV
25071-9503
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-8380
  • Fax:
Mailing address:
  • Phone: 304-415-5441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number103215
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: