Provider Demographics
NPI:1669024709
Name:BARNETTE, ALYSSA (PNP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BARNETTE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:FAIRBANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 SUNCREST TOWN CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1828
Mailing Address - Country:US
Mailing Address - Phone:304-599-2004
Mailing Address - Fax:
Practice Address - Street 1:1202 SUNCREST TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1828
Practice Address - Country:US
Practice Address - Phone:304-599-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV103907363LP0200X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care