Provider Demographics
NPI:1225079544
Name:STOTTS, MICHELLE L (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:STOTTS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:MID ATLANTIC ANESTHESIA CONSULTANTS
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1050
Mailing Address - Country:US
Mailing Address - Phone:304-346-9400
Mailing Address - Fax:304-345-7320
Practice Address - Street 1:720 PINNELL ST
Practice Address - Street 2:JACKSON GENERAL HOSPITAL
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271
Practice Address - Country:US
Practice Address - Phone:304-373-1544
Practice Address - Fax:304-373-0044
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV52711367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0207026000Medicaid
WVDA0096OtherRR MEDICARE
WV001721843OtherBCBS
WV001706470OtherMSBCBS
WV2605278000Medicaid
WVP00158674OtherRR MEDICARE
OH233080009300OtherOHIO WORKERS' COMP
WV270052997002OtherTRICARE
OH2435118Medicaid
OH2460484Medicaid
WV27005299700OtherBRICKSTREET
WV8230523Medicare PIN
WV9333201Medicare PIN