Healthcare Provider Details

I. General information

NPI: 1285264390
Provider Name (Legal Business Name): ROCHELLE HEATHCOCK APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUNCREST TOWN CENTRE DR STE 310
MORGANTOWN WV
26505-1873
US

IV. Provider business mailing address

600 SUNCREST TOWN CENTRE DR STE 310
MORGANTOWN WV
26505-1873
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-2200
  • Fax: 304-599-2674
Mailing address:
  • Phone: 304-598-2200
  • Fax: 304-599-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number104652
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: