Basic Information
| Provider Information | |||||||||
| NPI: | 1801146071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHIAS | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3647 US HIGHWAY 220 N | ||||||||
| Address2: | |||||||||
| City: | MOOREFIELD | ||||||||
| State: | WV | ||||||||
| PostalCode: | 268368643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045383131 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 MULLIGAN DRIVE | ||||||||
| Address2: | |||||||||
| City: | PETERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 268471511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042572451 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2012 | ||||||||
| LastUpdateDate: | 05/04/2015 | ||||||||
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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 | 71048 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.