Healthcare Provider Details

I. General information

NPI: 1134054794
Provider Name (Legal Business Name): HOMETOWN WELLNESS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 ELIZABETH DR
WESTON WV
26452-7057
US

IV. Provider business mailing address

37 ELIZABETH DR
WESTON WV
26452-7057
US

V. Phone/Fax

Practice location:
  • Phone: 304-476-4031
  • Fax:
Mailing address:
  • Phone: 304-476-4031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TYLER JENNINGS HALL
Title or Position: OWNER
Credential: DO
Phone: 304-476-4031