Healthcare Provider Details

I. General information

NPI: 1801712005
Provider Name (Legal Business Name): BROOKLYNN COATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SCOTT AVE STE 301
MORGANTOWN WV
26508-8857
US

IV. Provider business mailing address

20 SCOTT AVE STE 301
MORGANTOWN WV
26508-8857
US

V. Phone/Fax

Practice location:
  • Phone: 304-241-4000
  • Fax:
Mailing address:
  • Phone: 304-241-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number26-967SUD
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: