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General NPI Number Information
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NPI Number | 1396329769
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Entity Type | Organization
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Legal Business Name | HILLBILLY HEALTHCARE LLC
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 12 QUASAR DR
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City | MARTINSBURG
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State | WV
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Zip | 25405-7706
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Country | US
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Telephone | 304-839-3454
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Fax | 304-724-7399
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Provider Business Mailing Address
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Address Line | PO BOX 726
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City | KEARNEYSVILLE
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State | WV
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Zip | 25430-0726
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Country | US
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Telephone | 304-433-2229
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Fax | 304-724-7399
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Authorized Official
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Title or Position | DOCTORATE NURSE PRACTITIONER
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Name | DR. LEONA FAY COOK
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Credential | DNP-C
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Telephone | 304-433-2229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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