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General NPI Number Information
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NPI Number | 1710462395
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Entity Type | Individual
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Provider Name | CHARLES DAVID MCCORMICK APRN
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Gender | Male
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Dates
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Enumeration Date | 09/28/2018
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 1200 CENTRAL AVE STE 4
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City | ASHLAND
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State | KY
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Zip | 41101-7575
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Country | US
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Telephone | 606-324-1483
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Fax | 606-329-2612
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Provider Business Mailing Address
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Address Line | PO BOX 2379
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City | ASHLAND
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State | KY
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Zip | 41105-2379
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Country | US
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Telephone | 606-408-6200
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Fax | 606-408-6612
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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 | APRN.CNP.0030172
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN79987NO
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3012698
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License Number State | KY
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