Healthcare Provider Details

I. General information

NPI: 1568163731
Provider Name (Legal Business Name): ABBEY FONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL PARK STE 221
WHEELING WV
26003-6391
US

IV. Provider business mailing address

PO BOX 644118 PO BOX 644118
PITTSBURGH PA
15264-4118
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-8850
  • Fax:
Mailing address:
  • Phone: 304-974-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number115836
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: