Provider Demographics
NPI:1114517281
Name:LITTLE, LETHA KRISTEN (NP)
Entity Type:Individual
Prefix:
First Name:LETHA
Middle Name:KRISTEN
Last Name:LITTLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LETHA
Other - Middle Name:KRISTEN
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 RUFFNER DR
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1739
Mailing Address - Country:US
Mailing Address - Phone:304-646-3905
Mailing Address - Fax:
Practice Address - Street 1:176 DAWKINS DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9302
Practice Address - Country:US
Practice Address - Phone:304-793-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV108375363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner