Healthcare Provider Details

I. General information

NPI: 1760336671
Provider Name (Legal Business Name): MATALYN CLARK WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 VALLEY VIEW AVE
WHEELING WV
26003-1432
US

IV. Provider business mailing address

1208 VALLEY VIEW AVE
WHEELING WV
26003-1432
US

V. Phone/Fax

Practice location:
  • Phone: 304-771-0329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number109470
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: