Healthcare Provider Details

I. General information

NPI: 1609554393
Provider Name (Legal Business Name): ANN MARIE WHITEHAIR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 OAKMOUND RD
CLARKSBURG WV
26301-9398
US

IV. Provider business mailing address

1916 TRAP SPRINGS RD
GRAFTON WV
26354-8231
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-6330
  • Fax:
Mailing address:
  • Phone: 304-203-5320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number117096
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: