Provider Demographics
NPI:1093905895
Name:TEMPLETON, DESIRAE ANN (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:DESIRAE
Middle Name:ANN
Last Name:TEMPLETON
Suffix:
Gender:F
Credentials:MS, PA-C
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 35
Mailing Address - Street 2:
Mailing Address - City:NEWBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26410-0035
Mailing Address - Country:US
Mailing Address - Phone:304-892-2828
Mailing Address - Fax:304-892-2927
Practice Address - Street 1:725 N PIKE ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-1270
Practice Address - Country:US
Practice Address - Phone:304-265-4909
Practice Address - Fax:304-265-4915
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV394363AM0700X
WV01234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810025036Medicaid
WVP01623327Medicare PIN
WVWV0749BMedicare PIN
WV3810025036Medicaid
WVWV0749DMedicare PIN