Provider Demographics
NPI:1942268933
Name:OOTEN, SANDRA KAY (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:OOTEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4190
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-4190
Mailing Address - Country:US
Mailing Address - Phone:304-399-4405
Mailing Address - Fax:304-399-2526
Practice Address - Street 1:6475 FARMDALE RD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1321
Practice Address - Country:US
Practice Address - Phone:304-733-6333
Practice Address - Fax:304-733-6388
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP 15828363LF0000X
WV23475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092849Medicaid
WV0166837000Medicaid
KY78004751Medicaid
WVNP74644Medicare PIN
WV0166837000Medicaid