Healthcare Provider Details

I. General information

NPI: 1366090839
Provider Name (Legal Business Name): ALICIA MCINTIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PROSPECT LN
WHITE SULPHUR SPRINGS WV
24986-5055
US

IV. Provider business mailing address

125 PROSPECT LN
WHITE SULPHUR SPRINGS WV
24986-5055
US

V. Phone/Fax

Practice location:
  • Phone: 304-767-1465
  • Fax:
Mailing address:
  • Phone: 304-767-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: