Provider Demographics
NPI:1568073609
Name:HUNT, VERONICA JEAN
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:JEAN
Last Name:HUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 BLUEROOM ROAD
Mailing Address - Street 2:P.O. BOX 369
Mailing Address - City:MIDWAY
Mailing Address - State:WV
Mailing Address - Zip Code:25878-0369
Mailing Address - Country:US
Mailing Address - Phone:304-250-5661
Mailing Address - Fax:
Practice Address - Street 1:558 BLUE ROOM RD RD
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:WV
Practice Address - Zip Code:25878-2587
Practice Address - Country:US
Practice Address - Phone:304-250-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00702206068Medicaid