Provider Demographics
NPI:1750916011
Name:ARVESSA SKIN CARE CENTER LLC
Entity type:Organization
Organization Name:ARVESSA SKIN CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:304-261-9038
Mailing Address - Street 1:109 CHAGALL LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-8317
Mailing Address - Country:US
Mailing Address - Phone:304-261-9038
Mailing Address - Fax:
Practice Address - Street 1:710 SOMERSET BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-4998
Practice Address - Country:US
Practice Address - Phone:304-261-9038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty