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General NPI Number Information
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NPI Number | 1619579315
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Entity Type | Individual
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Provider Name | GWENDOLYN HUFFMAN PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 131 WELLNESS DR
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-5402
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Country | US
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Telephone | 304-872-2659
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Fax | 304-872-1685
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Provider Business Mailing Address
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Address Line | 131 WELLNESS DR
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-5402
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Country | US
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Telephone | 304-872-6503
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Fax | 304-872-5415
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 107706
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License Number State | WV
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