Healthcare Provider Details

I. General information

NPI: 1255264669
Provider Name (Legal Business Name): MADILYN ELIZABETH LIVELY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADILYN ELIZABETH BODKIN

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HARPER FARM LN
NIMITZ WV
25978-8542
US

IV. Provider business mailing address

34 HARPER FARM LN
NIMITZ WV
25978-8542
US

V. Phone/Fax

Practice location:
  • Phone: 304-663-6760
  • Fax:
Mailing address:
  • Phone: 304-663-6760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License Number113237
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: