Healthcare Provider Details

I. General information

NPI: 1720799083
Provider Name (Legal Business Name): HALIE AUTUMN TROUTEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WHEELING AVE
GLEN DALE WV
26038-1697
US

IV. Provider business mailing address

208 UNIVERSITY DR
WEST LIBERTY WV
26074-1082
US

V. Phone/Fax

Practice location:
  • Phone: 304-845-3211
  • Fax:
Mailing address:
  • Phone: 304-336-5098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2803
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: