Healthcare Provider Details

I. General information

NPI: 1639611882
Provider Name (Legal Business Name): KASEY MOWERY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 S MAIN ST
MOOREFIELD WV
26836-1238
US

IV. Provider business mailing address

PO BOX 97
BAKER WV
26801-0097
US

V. Phone/Fax

Practice location:
  • Phone: 304-538-2331
  • Fax: 304-538-2533
Mailing address:
  • Phone: 304-897-5915
  • Fax: 304-897-8472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113669
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: