Provider Demographics
NPI:1760808232
Name:UPTON, STEPHEN
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:UPTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 TRIBBLE RD
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:WV
Mailing Address - Zip Code:25123-9209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27353 CHARLESTON RD
Practice Address - Street 2:
Practice Address - City:LEON
Practice Address - State:WV
Practice Address - Zip Code:25123-9209
Practice Address - Country:US
Practice Address - Phone:304-812-4548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-08
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN73115-FNP-BC363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner