Healthcare Provider Details

I. General information

NPI: 1164333092
Provider Name (Legal Business Name): BETHANY J WOOLSEY MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 LMAH CENTER RD
LOGAN WV
25601-4058
US

IV. Provider business mailing address

115 CEDAR ST
LOGAN WV
25601-3048
US

V. Phone/Fax

Practice location:
  • Phone: 304-792-7130
  • Fax:
Mailing address:
  • Phone: 304-953-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN-CNP116509
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: