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General NPI Number Information
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NPI Number | 1558180091
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Entity Type | Individual
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Provider Name | CONNIE SUE YOKUM FNP
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Gender | Female
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Dates
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Enumeration Date | 10/09/2024
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 700 CHAPPELL RD
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City | CHARLESTON
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State | WV
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Zip | 25304-2704
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Country | US
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Telephone | 304-644-0504
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Fax |
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Provider Business Mailing Address
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Address Line | 1712 LAVALETTE AVE
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City | ELKINS
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State | WV
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Zip | 26241-3020
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Country | US
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Telephone | 304-614-8320
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 120488
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License Number State | WV
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