Provider Demographics
NPI:1063967461
Name:MOFFITT, PAIGE E (FNP-BC)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:E
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:E
Other - Last Name:MERRIFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:501 MORRIS ST
Mailing Address - Street 2:SUITE 357
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1326
Mailing Address - Country:US
Mailing Address - Phone:304-388-3574
Mailing Address - Fax:304-388-6461
Practice Address - Street 1:501 MORRIS ST
Practice Address - Street 2:SUITE 357
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1326
Practice Address - Country:US
Practice Address - Phone:304-388-3574
Practice Address - Fax:304-388-6461
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN82179-FNP-BC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily