Healthcare Provider Details

I. General information

NPI: 1114518123
Provider Name (Legal Business Name): STEVEN LEE JARVIS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 03/28/2024
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 SAND PLANT RD
SOUTH CHARLESTON WV
25309-6120
US

IV. Provider business mailing address

7400 LYNN AVE
HAMLIN WV
25523-1138
US

V. Phone/Fax

Practice location:
  • Phone: 304-756-1500
  • Fax: 304-756-1548
Mailing address:
  • Phone: 304-824-5806
  • Fax: 304-824-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number108504
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: