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General NPI Number Information
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NPI Number | 1225526304
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Entity Type | Organization
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Legal Business Name | APPALACHIANWELLNESS CLINIC INC
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 425 STANAFORD RD
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City | BECKLEY
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State | WV
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Zip | 25801-3145
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Country | US
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Telephone | 304-222-5817
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Fax |
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Provider Business Mailing Address
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Address Line | 56 OSPREY RD
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City | BECKLEY
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State | WV
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Zip | 25801-3684
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Country | US
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Telephone | 304-222-5817
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Fax |
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Authorized Official
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Title or Position | PHYSIAN ASSISTANT
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Name | MARYAM JAFARY RANA
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Credential | PA-C
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Telephone | 304-222-5817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 1717
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License Number State | WV
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