Provider Demographics
NPI:1457858102
Name:JUSTICE, LINDA J (FNP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:J
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 CRIDER DR
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-8855
Mailing Address - Country:US
Mailing Address - Phone:606-921-6805
Mailing Address - Fax:
Practice Address - Street 1:MARATHON PETROLEUM COMPANY LP
Practice Address - Street 2:8030 CRIDER DRIVE
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129
Practice Address - Country:US
Practice Address - Phone:606-921-6805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN81255-NP-C363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100536910Medicaid
OH0289619Medicaid
WV1457858102Medicaid