Provider Demographics
NPI:1639782303
Name:RITCHIE, SHANE CHARLES (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:CHARLES
Last Name:RITCHIE
Suffix:
Gender:M
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 1:3 HEALTHCARE DR
Mailing Address - Street 2:
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-9405
Mailing Address - Country:US
Mailing Address - Phone:304-457-1760
Mailing Address - Fax:304-457-1516
Practice Address - Street 1:3 HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-9405
Practice Address - Country:US
Practice Address - Phone:304-457-1760
Practice Address - Fax:304-457-1516
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV83496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV83496OtherWV RN LICENSE