Healthcare Provider Details

I. General information

NPI: 1528290087
Provider Name (Legal Business Name): MONICA LEAH MASON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MONICA LEAH MCCALLISTER

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BROOKS ST
CHARLESTON WV
25301-1319
US

IV. Provider business mailing address

601 BROOKS ST
CHARLESTON WV
25301-1319
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-8877
  • Fax: 304-414-5218
Mailing address:
  • Phone: 304-346-8877
  • Fax: 304-414-5218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN60712-NP
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: