Healthcare Provider Details

I. General information

NPI: 1245234228
Provider Name (Legal Business Name): SHAWN E CLINE-RIGGINS CR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E MCDONALD AVE
MAN WV
25635-1023
US

IV. Provider business mailing address

7400 LYNN AVE
HAMLIN WV
25523-1138
US

V. Phone/Fax

Practice location:
  • Phone: 304-583-8585
  • Fax: 304-583-0129
Mailing address:
  • Phone: 304-824-5806
  • Fax: 304-824-5804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number35199
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: