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General NPI Number Information
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NPI Number | 1720358252
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Entity Type | Organization
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Legal Business Name | PRESTON URGENT CARE FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 12/30/2011
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 411 MORGANTOWN ST
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City | KINGWOOD
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State | WV
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Zip | 26537-1095
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Country | US
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Telephone | 304-329-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 411 MORGANTOWN ST
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City | KINGWOOD
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State | WV
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Zip | 26537-1095
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Country | US
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Telephone | 304-329-0555
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | PEGGY S. PHILLIPS
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Credential |
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Telephone | 304-329-0555
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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 | 30549
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License Number State | WV
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