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NPI Code Detail

MEDICARE: MADISON EVANS FNP-BC

MEDICARE: MADISON EVANS FNP-BC
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
1163WS0200XSchool Registered Nurse101666WV
2363LF0000XFamily Nurse Practitioner124389WV

General Provider Information

NPI Number : 1790412880
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON EVANS FNP-BC
Provider Business Mailing Address
First Line : PO BOX 876
Second Line :
City : MORGANTOWN
State : WV
Zip : 26507-0876
Country : US
Telephone Number : 304-257-1026
Fax Number : 304-257-1412
Provider Business Practice Location Address
First Line : 117 HOSPITAL DR
Second Line :
City : PETERSBURG
State : WV
Zip : 26847-9566
Country : US
Telephone Number : 304-257-1026
Fax Number : 304-257-1412
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2022
Last Update Date : 02/05/2026

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Directions to “ MADISON EVANS FNP-BC” Practice Location

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