Provider Demographics
NPI:1760833966
Name:BENTLEY, MICA T (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:MICA
Middle Name:T
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MORRIS ST
Mailing Address - Street 2:SUITE 357
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1326
Mailing Address - Country:US
Mailing Address - Phone:304-388-3574
Mailing Address - Fax:304-388-6481
Practice Address - Street 1:501 MORRIS ST
Practice Address - Street 2:SUITE 357
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1326
Practice Address - Country:US
Practice Address - Phone:304-388-3574
Practice Address - Fax:304-388-6481
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN73471-NP-C363LF0000X
WV73471363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health