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General NPI Number Information
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NPI Number | 1750916011
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Entity Type | Organization
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Legal Business Name | ARVESSA SKIN CARE CENTER LLC
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Dates
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Enumeration Date | 03/06/2020
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 710 SOMERSET BLVD STE 103
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City | CHARLES TOWN
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State | WV
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Zip | 25414-4998
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Country | US
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Telephone | 304-261-9038
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Fax |
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Provider Business Mailing Address
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Address Line | 109 CHAGALL LN
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City | MARTINSBURG
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State | WV
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Zip | 25403-8317
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Country | US
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Telephone | 304-261-9038
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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 | MS. KERRY COLE
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Credential | APRN-BC
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Telephone | 304-261-9038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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