Healthcare Provider Details

I. General information

NPI: 1851246912
Provider Name (Legal Business Name): WOOTEN FAMILY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 24TH STREET
KOPPERSTON WV
24854
US

IV. Provider business mailing address

PO BOX 268
OCEANA WV
24870-0268
US

V. Phone/Fax

Practice location:
  • Phone: 304-932-2122
  • Fax:
Mailing address:
  • Phone: 304-932-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS WOOTEN
Title or Position: OWNER
Credential: MBA
Phone: 304-932-2122