Provider Demographics
NPI:1669436853
Name:RUSKIN, MELODY H (FNP-BC)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:H
Last Name:RUSKIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:H
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:176 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RAINELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25962-1064
Mailing Address - Country:US
Mailing Address - Phone:304-438-6188
Mailing Address - Fax:304-438-6819
Practice Address - Street 1:350 W. OYLER AVENUE
Practice Address - Street 2:OAK HILL HIGH SCHOOL
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901
Practice Address - Country:US
Practice Address - Phone:304-469-2905
Practice Address - Fax:304-469-6332
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV57241363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005940Medicaid
WV3810005940Medicaid
Q57968Medicare UPIN
WV2029975Medicare PIN