Healthcare Provider Details

I. General information

NPI: 1225270044
Provider Name (Legal Business Name): PATTY HERMOSILLA BC-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 VIKING DRIVE
JANE LEW WV
26378
US

IV. Provider business mailing address

10 PHEASANT DR
FAIRMONT WV
26554-1247
US

V. Phone/Fax

Practice location:
  • Phone: 304-266-1624
  • Fax:
Mailing address:
  • Phone: 304-612-0374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number38002
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: