Provider Demographics
NPI:1003832973
Name:PING, ERIC L (ACNP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:PING
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4190
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-4190
Mailing Address - Country:US
Mailing Address - Phone:304-399-4405
Mailing Address - Fax:304-399-2526
Practice Address - Street 1:2828 1ST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1236
Practice Address - Country:US
Practice Address - Phone:304-399-7530
Practice Address - Fax:304-399-7532
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-07664363L00000X
IN28147923A163W00000X
FLARNP9256944363LF0000X
WV79219363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7103250000Medicaid
001714159OtherMOUNTAIN STATE BCBS
KY7100148470Medicaid
WVP00924317OtherRR MEDICAID
OH2509824OtherMOLINA MEDICAID
P00129285OtherRR MEDICARE
WVNP39681Medicare UPIN
OHNP15332Medicare PIN