Provider Demographics
NPI:1982899639
Name:WOODS, CHARITY DELANE KNICELEY (APRN, BC)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:DELANE KNICELEY
Last Name:WOODS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-1323
Mailing Address - Country:US
Mailing Address - Phone:304-765-2225
Mailing Address - Fax:304-765-3072
Practice Address - Street 1:404 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-1323
Practice Address - Country:US
Practice Address - Phone:304-765-2225
Practice Address - Fax:304-765-3072
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV56272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810012244Medicaid
WV2033186Medicare PIN
WV2033187Medicare PIN
WV3810012244Medicaid
WV2033189Medicare PIN
WV2033188Medicare PIN
WV2031126Medicare PIN
WV2033185Medicare PIN