Healthcare Provider Details

I. General information

NPI: 1790690287
Provider Name (Legal Business Name): STACY SHEPPARD WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 COUGAR MOUNTAIN DR
WINFIELD WV
25213-7697
US

IV. Provider business mailing address

233 COUGAR MOUNTAIN DR
WINFIELD WV
25213-7697
US

V. Phone/Fax

Practice location:
  • Phone: 304-993-4511
  • Fax: 800-522-4948
Mailing address:
  • Phone: 304-993-4511
  • Fax: 800-522-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: STACY SHEPPARD
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 304-993-4511