Basic Information
| Provider Information | |||||||||
| NPI: | 1578878211 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCALLISTER | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | RN, MSN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 457 | ||||||||
| Address2: | |||||||||
| City: | WHITE SULPHUR SPRINGS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249860457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045365030 | ||||||||
| FaxNumber: | 3045365031 | ||||||||
| Practice Location | |||||||||
| Address1: | 3738 DAVIS STUART RD | ||||||||
| Address2: | |||||||||
| City: | LEWISBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249019740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408627064 | ||||||||
| FaxNumber: | 5408625727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2010 | ||||||||
| LastUpdateDate: | 02/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 68873 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 002608991 | 01 | WV | BLUE CROSS BLUE SHEILD | OTHER |