Healthcare Provider Details

I. General information

NPI: 1851124374
Provider Name (Legal Business Name): MADISON SKEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE JOHN MARSHALL DRIVE SKH HALL
HUNTINGTON WV
25755-0001
US

IV. Provider business mailing address

108 WOODSIDE ST
HURRICANE WV
25526-1050
US

V. Phone/Fax

Practice location:
  • Phone: 304-696-7302
  • Fax:
Mailing address:
  • Phone: 304-543-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberIN0010524
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: