Provider Demographics
NPI:1245666817
Name:COLEGROVE, AIMEE MICHELLE (APN)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:MICHELLE
Last Name:COLEGROVE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:AIMEE
Other - Middle Name:MICHELLE
Other - Last Name:FERRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:872 ROUTE 65
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-7497
Mailing Address - Country:US
Mailing Address - Phone:304-475-3700
Mailing Address - Fax:304-475-3780
Practice Address - Street 1:872 ROUTE 65
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-7497
Practice Address - Country:US
Practice Address - Phone:304-475-3700
Practice Address - Fax:304-475-3780
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV57377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVF0913283OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS