Provider Demographics
NPI:1154885895
Name:SEACRIST, MARYLEA RUTH (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARYLEA
Middle Name:RUTH
Last Name:SEACRIST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37456 COAL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25209-9077
Mailing Address - Country:US
Mailing Address - Phone:304-854-1323
Mailing Address - Fax:
Practice Address - Street 1:275 DRY HILL ROAD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2604
Practice Address - Country:US
Practice Address - Phone:304-253-6060
Practice Address - Fax:304-929-2248
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV89208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily