Healthcare Provider Details

I. General information

NPI: 1053191684
Provider Name (Legal Business Name): ALECIA ANN PATTON CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MIDDLETOWN CMNS STE 163
FAIRMONT WV
26554-2882
US

IV. Provider business mailing address

1247 SUNCREST TOWN CENTRE DR
MORGANTOWN WV
26505-1876
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-8000
  • Fax:
Mailing address:
  • Phone: 304-599-8000
  • Fax: 304-599-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number117791
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number101041
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: