Healthcare Provider Details

I. General information

NPI: 1912508854
Provider Name (Legal Business Name): JUNETA SPURLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/08/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25072 NORTHWESTERN PIKE
ROMNEY WV
26757-5039
US

IV. Provider business mailing address

456 FAWN RDG
PETERSBURG WV
26847-8050
US

V. Phone/Fax

Practice location:
  • Phone: 304-822-2177
  • Fax:
Mailing address:
  • Phone: 540-836-5452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number52458
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number52458
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number52458
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number52458
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: