Provider Demographics
NPI:1568568210
Name:NUTTER, JOANN (C-FNP)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:NUTTER
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 S PIKE ST
Mailing Address - Street 2:STE A
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-1043
Mailing Address - Country:US
Mailing Address - Phone:304-624-4655
Mailing Address - Fax:304-624-3918
Practice Address - Street 1:302 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:WV
Practice Address - Zip Code:26456-1108
Practice Address - Country:US
Practice Address - Phone:304-873-2590
Practice Address - Fax:304-873-1792
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0166946000Medicaid
WV0166946000Medicaid
WVNP12851Medicare PIN
WVNP12854Medicare PIN
WVNP12853Medicare PIN