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General NPI Number Information
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NPI Number | 1013524057
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Entity Type | Organization
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Legal Business Name | AMARIS MEDICAL, LLC
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 76 LEWIS STREET
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City | WHITESVILLE
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State | WV
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Zip | 25209
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Country | US
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Telephone | 304-896-0268
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Fax | 304-896-0289
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | WHITESVILLE
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State | WV
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Zip | 25209-0130
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Country | US
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Telephone | 304-896-0268
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Fax | 304-896-0289
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Authorized Official
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Title or Position | OWNER
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Name | ANGEL L STOVER
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Credential | APRN
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Telephone | 681-207-7007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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