MEDICARE: JUSTIN TYLER COMBS MSN, APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	104384	WV

General Provider Information

NPI Number	:	1093442220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN TYLER COMBS MSN, APRN, FNP-C

Provider Business Mailing Address
First Line	:	1458 GEORGES RUN RD
Second Line	:
City	:	KEYSER
State	:	WV
Zip	:	26726-6366
Country	:	US
Telephone Number	:	304-596-1951
Fax Number	:

Provider Business Practice Location Address
First Line	:	10261 FRANKFORT HWY UNIT 3
Second Line	:
City	:	FORT ASHBY
State	:	WV
Zip	:	26719-4533
Country	:	US
Telephone Number	:	304-597-3600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2022
Last Update Date	:	08/08/2022

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