=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477294692
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAYNE WESTLEY ANKROM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2022
-----------------------------------------------------
Last Update Date | 04/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2323 MURDOCH AVE
-----------------------------------------------------
City | PARKERSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26101-2532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-422-2884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 WILLOWBROOK DR
-----------------------------------------------------
City | PARKERSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26104-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-482-7528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------