Provider Demographics
NPI:1508230152
Name:CLAXTON, REBECCA ASHLEY (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ASHLEY
Last Name:CLAXTON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:3100 MACCORKLE AVE SE STE 900
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1223
Mailing Address - Country:US
Mailing Address - Phone:304-388-5880
Mailing Address - Fax:304-388-5858
Practice Address - Street 1:3100 MACCORKLE AVE SE STE 900
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-5880
Practice Address - Fax:304-388-5858
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV76771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1508230152Medicaid