Provider Demographics
NPI:1740524875
Name:GUNNOE, ERICA DIANE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:DIANE
Last Name:GUNNOE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:ERICA
Other - Middle Name:DIANE
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:12576 WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-7315
Mailing Address - Country:US
Mailing Address - Phone:304-586-0111
Mailing Address - Fax:304-586-0114
Practice Address - Street 1:2014 HUBER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-2236
Practice Address - Country:US
Practice Address - Phone:304-552-4534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN70226-FNP-BC363LF0000X
WVAPRN70226363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1740524875Medicaid
WV1740524875Medicaid
WV3810024049OtherGROUP MEDICAID
WV4940B441Medicare PIN