Healthcare Provider Details

I. General information

NPI: 1073862363
Provider Name (Legal Business Name): CARLEY JO ELSWICK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2012
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MAIN ST STE 104
WHEELING WV
26003-2737
US

IV. Provider business mailing address

975 ROSTRAVER RD
ROSTRAVER TOWNSHIP PA
15012-1946
US

V. Phone/Fax

Practice location:
  • Phone: 681-821-2053
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax: 401-216-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN70488
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP012322
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: