Healthcare Provider Details

I. General information

NPI: 1417829847
Provider Name (Legal Business Name): MATTHEW PARKINSON MSN-PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 DOCTOR OATES DR STE 105
MARTINSBURG WV
25401-8896
US

IV. Provider business mailing address

2010 DOCTOR OATES DR STE 105
MARTINSBURG WV
25401-8896
US

V. Phone/Fax

Practice location:
  • Phone: 304-596-5780
  • Fax: 304-596-5781
Mailing address:
  • Phone: 304-596-5780
  • Fax: 304-596-5781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number105177
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: