Healthcare Provider Details

I. General information

NPI: 1831531904
Provider Name (Legal Business Name): LETITIA JEAN GOLDEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 10/12/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 OAKMOUND RD
CLARKSBURG WV
26301
US

IV. Provider business mailing address

706 OAKMOUND RD
CLARKSBURG WV
26301
US

V. Phone/Fax

Practice location:
  • Phone: 304-622-7511
  • Fax: 304-924-5460
Mailing address:
  • Phone: 304-622-7511
  • Fax: 304-924-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77023
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN77023
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: