Provider Demographics
NPI:1942951868
Name:ECKELBERRY, ALLYSON JO
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:JO
Last Name:ECKELBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 WYLIE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-6228
Mailing Address - Country:US
Mailing Address - Phone:740-607-5298
Mailing Address - Fax:
Practice Address - Street 1:3603 WYLIE RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-6228
Practice Address - Country:US
Practice Address - Phone:740-607-5298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant