Healthcare Provider Details

I. General information

NPI: 1871231902
Provider Name (Legal Business Name): THOMAS WILLIAM ANSELL FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 E PORTAL ROAD
DAVIS WV
26260
US

IV. Provider business mailing address

200 CLIFF MINE ROAD SUITE 500
PITTSBURGH PA
15275
US

V. Phone/Fax

Practice location:
  • Phone: 304-259-4970
  • Fax: 681-478-1170
Mailing address:
  • Phone: 878-201-3312
  • Fax: 878-201-3584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number114384
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP025795
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number532231
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: