Basic Information
| Provider Information | |||||||||
| NPI: | 1508508144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCRAGGS | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 293 | ||||||||
| Address2: | |||||||||
| City: | HAMLIN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255230293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3049626743 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6354 US ROUTE 60 E | ||||||||
| Address2: | |||||||||
| City: | BARBOURSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 255041247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047331626 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2022 | ||||||||
| LastUpdateDate: | 04/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 39176 | WV | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.