Provider Demographics
NPI:1578878211
Name:MCCALLISTER, ELIZABETH NICOLE (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NICOLE
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
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Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-0457
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:3738 DAVIS STUART RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9740
Practice Address - Country:US
Practice Address - Phone:540-862-7064
Practice Address - Fax:540-862-5727
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV68873363LF0000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV002608991OtherBLUE CROSS BLUE SHEILD
WV002608991OtherBLUE CROSS BLUE SHEILD