Healthcare Provider Details

I. General information

NPI: 1336620590
Provider Name (Legal Business Name): EMILY DORCAS STARKS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHCARE DR
PHILIPPI WV
26416-9405
US

IV. Provider business mailing address

1 HEALTHCARE DR
PHILIPPI WV
26416-9405
US

V. Phone/Fax

Practice location:
  • Phone: 304-457-1760
  • Fax: 304-457-3781
Mailing address:
  • Phone: 304-457-1760
  • Fax: 304-457-3781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN69116NP
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: