Basic Information
| Provider Information | |||||||||
| NPI: | 1285975383 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MED EXPRESS PRINCETON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 478 BLAKE HOLLOW RD | ||||||||
| Address2: | |||||||||
| City: | MOUNT HOPE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258806556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3048776592 | ||||||||
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| Practice Location | |||||||||
| Address1: | 277 GREASY RIDGE ROAD | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 24740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044257615 | ||||||||
| FaxNumber: | 3044257635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2013 | ||||||||
| LastUpdateDate: | 03/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUMPHREY | ||||||||
| AuthorizedOfficialFirstName: | JEANNETTE | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | FAMILY NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 3048776592 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | 60610 | WV | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.