Healthcare Provider Details

I. General information

NPI: 1518061977
Provider Name (Legal Business Name): AMY ELIZABETH KITZMILLER WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MON HEALTH MEDICAL PARK DR STE 2100
MORGANTOWN WV
26505-1168
US

IV. Provider business mailing address

2000 MON HEALTH MEDICAL PARK DR STE 2100
MORGANTOWN WV
26505-1168
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-6811
  • Fax: 304-599-7159
Mailing address:
  • Phone: 304-599-6811
  • Fax: 304-599-7159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP004562V
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN46057
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: