Healthcare Provider Details

I. General information

NPI: 1114693413
Provider Name (Legal Business Name): MICHELLE LYNN PAQUETTE MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 MORGANTOWN AVE
FAIRMONT WV
26554-4335
US

IV. Provider business mailing address

14 E GRAFTON RD STE C
FAIRMONT WV
26554-4465
US

V. Phone/Fax

Practice location:
  • Phone: 304-551-2815
  • Fax:
Mailing address:
  • Phone: 681-391-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: