Provider Demographics
NPI:1821665316
Name:SHORT, JOHNNA RALONN (NP)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:RALONN
Last Name:SHORT
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Mailing Address - Street 1:1247 SUNCREST TOWN CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1876
Mailing Address - Country:US
Mailing Address - Phone:304-599-8000
Mailing Address - Fax:304-599-8003
Practice Address - Street 1:139 CONFERENCE CENTER WAY STE 113
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9147
Practice Address - Country:US
Practice Address - Phone:304-599-8003
Practice Address - Fax:304-599-8003
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV108483363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics