Healthcare Provider Details

I. General information

NPI: 1093905895
Provider Name (Legal Business Name): DESIRAE ANN TEMPLETON MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N PIKE ST
GRAFTON WV
26354-1270
US

IV. Provider business mailing address

25 W BLUEMONT ST
GRAFTON WV
26354-1242
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-4909
  • Fax: 304-265-4915
Mailing address:
  • Phone: 304-265-0312
  • Fax: 304-265-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number01234
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number394
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: