Healthcare Provider Details

I. General information

NPI: 1518643394
Provider Name (Legal Business Name): MARY BETH MORRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 MERCER ST SUITE D
PRINCETON WV
24740
US

IV. Provider business mailing address

1300 EAST MAIN STREET
PRINCETON WV
24740
US

V. Phone/Fax

Practice location:
  • Phone: 304-431-2443
  • Fax:
Mailing address:
  • Phone: 304-308-9542
  • 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: