Basic Information
| Provider Information | |||||||||
| NPI: | 1225506975 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHOONOVER | ||||||||
| FirstName: | MERCEDES | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JOHNSON | ||||||||
| OtherFirstName: | MERCEDES | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1802 4TH ST | ||||||||
| Address2: | |||||||||
| City: | RICHLANDS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 246412308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3049609739 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5296 REDBUD HWY | ||||||||
| Address2: | |||||||||
| City: | HONAKER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242607379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2769919500 | ||||||||
| FaxNumber: | 2769914399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2018 | ||||||||
| LastUpdateDate: | 11/10/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0001238291 | VA | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 0024176875 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.