Provider Demographics
NPI:1215820576
Name:DENNISON, MISTY
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:DENNISON
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 JENNINGS DR
Mailing Address - Street 2:
Mailing Address - City:EXCHANGE
Mailing Address - State:WV
Mailing Address - Zip Code:26619-7560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 JENNINGS DR
Practice Address - Street 2:
Practice Address - City:EXCHANGE
Practice Address - State:WV
Practice Address - Zip Code:26619-7560
Practice Address - Country:US
Practice Address - Phone:304-651-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide