Healthcare Provider Details

I. General information

NPI: 1467827550
Provider Name (Legal Business Name): SUMMERE SEELE CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUMMERE HERNDON APRN,CPNP-PC

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 PARKVIEW DR
KEYSER WV
26726-2313
US

IV. Provider business mailing address

164 PARKVIEW DR
KEYSER WV
26726-2313
US

V. Phone/Fax

Practice location:
  • Phone: 304-597-2494
  • Fax: 304-597-2497
Mailing address:
  • Phone: 304-597-2494
  • Fax: 304-597-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number111962
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: