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General NPI Number Information
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NPI Number | 1053608588
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Entity Type | Individual
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Provider Name | NICOLE R OURS DO
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Gender | Female
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 422 S MAIN ST
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City | MOOREFIELD
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State | WV
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Zip | 26836-1238
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Country | US
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Telephone | 304-538-2331
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 97
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City | BAKER
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State | WV
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Zip | 26801-0097
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Country | US
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Telephone | 803-435-5270
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Fax | 304-897-5915
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2732
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License Number State | WV
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