Provider Demographics
NPI:1700028784
Name:WEGHORST, HOLLY (PA-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:WEGHORST
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-7900
Mailing Address - Country:US
Mailing Address - Phone:304-598-4855
Mailing Address - Fax:304-598-6831
Practice Address - Street 1:1 STADIUM DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-7900
Practice Address - Country:US
Practice Address - Phone:304-598-4855
Practice Address - Fax:304-598-6831
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01404363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical