Provider Demographics
NPI:1255748166
Name:CLINE, SIDNEY JEROME (APRN)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:JEROME
Last Name:CLINE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:JEROME
Other - Middle Name:
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:7400 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1138
Mailing Address - Country:US
Mailing Address - Phone:304-824-5806
Mailing Address - Fax:304-824-5804
Practice Address - Street 1:122 NICK SAVAS DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3468
Practice Address - Country:US
Practice Address - Phone:304-752-8081
Practice Address - Fax:304-752-8083
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN75819NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVAPRN75819NPOtherSTATE LICENSE