Healthcare Provider Details

I. General information

NPI: 1730883141
Provider Name (Legal Business Name): TISHA NICOLE MARSH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 GORMAN AVE
ELKINS WV
26241-3181
US

IV. Provider business mailing address

1 HEALTHCARE DR
PHILIPPI WV
26416-9405
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-3300
  • Fax:
Mailing address:
  • Phone: 304-457-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number80735
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number80735
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number80735
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: