Provider Demographics
NPI:1831531904
Name:GOLDEN, LETITIA JEAN (FNP-BC)
Entity type:Individual
Prefix:
First Name:LETITIA
Middle Name:JEAN
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 OAKMOUND RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301
Mailing Address - Country:US
Mailing Address - Phone:304-622-7511
Mailing Address - Fax:304-924-5460
Practice Address - Street 1:706 OAKMOUND RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301
Practice Address - Country:US
Practice Address - Phone:304-622-7511
Practice Address - Fax:304-924-5460
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV77023363LF0000X
WVAPRN77023363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV77023OtherFNP LICENSE
WV3810026224Medicaid