Provider Demographics
NPI:1710963103
Name:DUNCAN, JANELDA RAE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JANELDA
Middle Name:RAE
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 MACCORKLE SEAVE B16
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1227
Mailing Address - Country:US
Mailing Address - Phone:304-388-5848
Mailing Address - Fax:304-388-9654
Practice Address - Street 1:4407 MACCORKLE AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2541
Practice Address - Country:US
Practice Address - Phone:304-925-0392
Practice Address - Fax:304-925-0396
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV00825363A00000X
WV825363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DUPA16456Medicare PIN
DUPA16457Medicare PIN
WVP23623Medicare UPIN