Provider Demographics
NPI:1720279979
Name:PRETTYMAN, MARCIE M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:M
Last Name:PRETTYMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:MARIE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2000 MON HEALTH MEDICAL PARK DR STE 2100
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1134
Mailing Address - Country:US
Mailing Address - Phone:304-599-6811
Mailing Address - Fax:304-599-7159
Practice Address - Street 1:2000 MON HEALTH MEDICAL PARK DR STE 2100
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-599-6811
Practice Address - Fax:304-599-7159
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002580363AM0700X
WV01569363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical