Healthcare Provider Details

I. General information

NPI: 1508208117
Provider Name (Legal Business Name): LYNN CATHERINE MORELAND CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 11/24/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3952 TEAYS VALLEY RD
HURRICANE WV
25526-8728
US

IV. Provider business mailing address

3952 TEAYS VALLEY RD
HURRICANE WV
25526-8728
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-6736
  • Fax: 304-757-0582
Mailing address:
  • Phone: 304-757-6736
  • Fax: 304-757-0582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberWV 54772
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: