MEDICARE: CARRIE LETT NP

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	363L00000X	Nurse Practitioner	104459	WV

General Provider Information

NPI Number	:	1174142434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE LETT NP

Provider Business Mailing Address
First Line	:	522 GRAND CENTRAL AVE
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-2169
Country	:	US
Telephone Number	:	304-295-3331
Fax Number	:	304-295-4924

Provider Business Practice Location Address
First Line	:	522 GRAND CENTRAL AVE
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-2169
Country	:	US
Telephone Number	:	304-295-3331
Fax Number	:	304-295-4924

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

Provider Enumeration Date	:	04/15/2020
Last Update Date	:	04/15/2020

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Directions to “ CARRIE LETT NP” Practice Location

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