Provider Demographics
NPI:1508635533
Name:HAMILTON, MIRANDA (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-1826
Mailing Address - Country:US
Mailing Address - Phone:304-927-1495
Mailing Address - Fax:
Practice Address - Street 1:146 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-1826
Practice Address - Country:US
Practice Address - Phone:304-927-1495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV118045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily