Healthcare Provider Details

I. General information

NPI: 1518859909
Provider Name (Legal Business Name): GENTRY ANN MORRONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 12/19/2025
Certification Date: 07/18/2025
Deactivation Date: 07/18/2025
Reactivation Date: 12/19/2025

III. Provider practice location address

207 FAIRMONT AVE
FAIRMONT WV
26554-2710
US

IV. Provider business mailing address

207 FAIRMONT AVE
FAIRMONT WV
26554-2710
US

V. Phone/Fax

Practice location:
  • Phone: 681-404-6869
  • Fax:
Mailing address:
  • Phone: 681-404-6869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number296
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: