Basic Information
| Provider Information | |||||||||
| NPI: | 1851489157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUCKETT | ||||||||
| FirstName: | FRANKIE | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 DUNCAN ROAD | ||||||||
| Address2: | |||||||||
| City: | BUCKEYE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249249643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047997400 | ||||||||
| FaxNumber: | 3047992276 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 DUNCAN ROAD | ||||||||
| Address2: | |||||||||
| City: | BUCKEYE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249249643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047997400 | ||||||||
| FaxNumber: | 3047992276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 10/10/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD426102 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 208G00000X | 22820 | WV | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208600000X | 22820 | WV | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3810018033 | 05 | WV | MEDICAID |