Healthcare Provider Details

I. General information

NPI: 1184958472
Provider Name (Legal Business Name): DERMATOLOGY CENTER FOR SKIN HEALTH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUNCREST TOWN CENTRE DR SUITE 115
MORGANTOWN WV
26505-1872
US

IV. Provider business mailing address

600 SUNCREST TOWN CENTRE DR SUITE 115
MORGANTOWN WV
26505-1872
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-3888
  • Fax: 304-598-0564
Mailing address:
  • Phone: 304-598-3888
  • Fax: 304-598-0564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number54321
License Number StateWV

VIII. Authorized Official

Name: RACHEL ELISABETH WAYBRIGHT
Title or Position: PRACTICE ADMINISTRATOR
Credential: MPA
Phone: 304-225-2236