Healthcare Provider Details

I. General information

NPI: 1477002327
Provider Name (Legal Business Name): RACHEL CAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLIERS WAY STE 410
WEIRTON WV
26062-5055
US

IV. Provider business mailing address

651 COLLIERS WAY STE 300
WEIRTON WV
26062-5058
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-1172
  • Fax:
Mailing address:
  • Phone: 304-797-6404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number026410
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number105865
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number85607
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: