Healthcare Provider Details

I. General information

NPI: 1316825961
Provider Name (Legal Business Name): MIKAYLA CROUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311C MALL RD
OAK HILL WV
25901-6113
US

IV. Provider business mailing address

19 WESTGATE ESTATES RD
ALDERSON WV
24910-1132
US

V. Phone/Fax

Practice location:
  • Phone: 304-465-3302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: