Healthcare Provider Details

I. General information

NPI: 1356210876
Provider Name (Legal Business Name): SANDRA KAY VANCE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E 2ND AVE STE 100
WILLIAMSON WV
25661-3601
US

IV. Provider business mailing address

PO BOX 390
HUNTINGTON WV
25708-0390
US

V. Phone/Fax

Practice location:
  • Phone: 304-443-0233
  • Fax:
Mailing address:
  • Phone: 304-429-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number124386
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number124386
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: