Healthcare Provider Details

I. General information

NPI: 1689671703
Provider Name (Legal Business Name): BARBARA FAHEY C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3136 WEST ST
WEIRTON WV
26062-4637
US

IV. Provider business mailing address

3136 WEST ST
WEIRTON WV
26062-4637
US

V. Phone/Fax

Practice location:
  • Phone: 304-797-7733
  • Fax: 304-797-7740
Mailing address:
  • Phone: 304-797-7733
  • Fax: 304-797-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOANP4982
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53939
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: