Healthcare Provider Details

I. General information

NPI: 1912483447
Provider Name (Legal Business Name): MOLLY B. WHITE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KENTON DR STE 100
CHARLESTON WV
25311-1256
US

IV. Provider business mailing address

1 KENTON DR STE 100
CHARLESTON WV
25311-1256
US

V. Phone/Fax

Practice location:
  • Phone: 304-306-8990
  • Fax: 877-471-5976
Mailing address:
  • Phone: 304-306-8990
  • Fax: 877-471-5976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN88642-NP-C
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number88642
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: