Healthcare Provider Details

I. General information

NPI: 1881442937
Provider Name (Legal Business Name): HEATHER NICOLE BUMGARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BB WAY
HURRICANE WV
25526-1094
US

IV. Provider business mailing address

90 BB WAY
HURRICANE WV
25526-1094
US

V. Phone/Fax

Practice location:
  • Phone: 304-919-5889
  • Fax:
Mailing address:
  • Phone: 304-919-5889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW032216166
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: