Provider Demographics
NPI:1013982495
Name:KAUFMAN, JANICE K (FNP-C)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:K
Last Name:KAUFMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:K
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:CAMC OUTPATIENT CLINICS
Mailing Address - Street 2:3200 MACCORKLE AVENUE SE
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-388-5590
Mailing Address - Fax:304-388-8238
Practice Address - Street 1:3100 MACCORKLE AVE
Practice Address - Street 2:SUITE 709
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-342-1184
Practice Address - Fax:304-343-8487
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7105184000Medicaid
WVP61395Medicare UPIN
WV7105184000Medicaid