Provider Demographics
NPI:1902860158
Name:FABRY, SUSAN K (CPNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:FABRY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3656
Mailing Address - Country:US
Mailing Address - Phone:304-691-1300
Mailing Address - Fax:304-691-1330
Practice Address - Street 1:1600 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 3500
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3656
Practice Address - Country:US
Practice Address - Phone:304-691-1300
Practice Address - Fax:304-691-1330
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV27383363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7102194000Medicaid
OH2308363Medicaid
KY78009610Medicaid
KY78009610Medicaid
OH2308363Medicaid