Provider Demographics
NPI:1447763511
Name:NEW HOPE FUNCTIONAL MEDICINE LLC
Entity Type:Organization
Organization Name:NEW HOPE FUNCTIONAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:304-479-2580
Mailing Address - Street 1:242 SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WINTERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-7266
Mailing Address - Country:US
Mailing Address - Phone:304-479-2580
Mailing Address - Fax:304-264-5777
Practice Address - Street 1:117 B THREE SPRINGS DRIVE
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062
Practice Address - Country:US
Practice Address - Phone:304-723-2494
Practice Address - Fax:304-723-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV83280363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty