Healthcare Provider Details

I. General information

NPI: 1689921587
Provider Name (Legal Business Name): ANGELA FAYE MARTIN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEALTH CENTER DR
UNION WV
24983-8442
US

IV. Provider business mailing address

134 ELON RD
MADISON HEIGHTS VA
24572-2536
US

V. Phone/Fax

Practice location:
  • Phone: 304-772-3064
  • Fax:
Mailing address:
  • Phone: 434-455-2480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024170251
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: