Provider Demographics
NPI:1912359969
Name:ROY, JINA J (APN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JINA
Middle Name:J
Last Name:ROY
Suffix:
Gender:F
Credentials:APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2235
Mailing Address - Country:US
Mailing Address - Phone:304-473-5600
Mailing Address - Fax:304-472-1341
Practice Address - Street 1:37 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2235
Practice Address - Country:US
Practice Address - Phone:304-473-5600
Practice Address - Fax:304-472-1341
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV86554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV86554OtherLICENSE