Provider Demographics
NPI:1114674892
Name:LAFFERTY, RACHEAL NICOLE (PA)
Entity type:Individual
Prefix:
First Name:RACHEAL
Middle Name:NICOLE
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 RURAL ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3503
Mailing Address - Country:US
Mailing Address - Phone:304-253-2628
Mailing Address - Fax:304-252-1720
Practice Address - Street 1:351 4H LAKE RD
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-9531
Practice Address - Country:US
Practice Address - Phone:304-877-8215
Practice Address - Fax:304-763-4275
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV854363AS0400X
390200000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program