Provider Demographics
NPI:1912593732
Name:PREVATTE, MISTY DAWN
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:DAWN
Last Name:PREVATTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2720
Mailing Address - Country:US
Mailing Address - Phone:304-413-3512
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:231 MILL ROAD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WV
Practice Address - Zip Code:26807-2680
Practice Address - Country:US
Practice Address - Phone:304-358-2421
Practice Address - Fax:304-358-2422
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker