Healthcare Provider Details

I. General information

NPI: 1093442220
Provider Name (Legal Business Name): JUSTIN TYLER COMBS MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10261 FRANKFORT HWY UNIT 3
FORT ASHBY WV
26719-4533
US

IV. Provider business mailing address

1458 GEORGES RUN RD
KEYSER WV
26726-6366
US

V. Phone/Fax

Practice location:
  • Phone: 304-597-3600
  • Fax:
Mailing address:
  • Phone: 304-596-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number104384
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: