Provider Demographics
NPI:1013956945
Name:OATES, CONSTANCE J (FNP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:J
Last Name:OATES
Suffix:
Gender:F
Credentials:FNP
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 128
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:WV
Mailing Address - Zip Code:26184-0128
Mailing Address - Country:US
Mailing Address - Phone:304-464-4008
Mailing Address - Fax:904-346-0113
Practice Address - Street 1:401 MATTHEW ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1635
Practice Address - Country:US
Practice Address - Phone:740-376-1939
Practice Address - Fax:740-374-1693
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN24642-FNP-BC363L00000X
OHAPRN.CNP.0925363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3031221Medicaid
WV7104163000Medicaid
OH3031221Medicaid
WVP00248398OtherRAILROAD MEDICARE
WV7104163000Medicaid
WVOANP12282Medicare ID - Type Unspecified