Provider Demographics
NPI:1285703108
Name:ROWE, JEFFREY LEE (ACNP)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEE
Last Name:ROWE
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25712-0910
Mailing Address - Country:US
Mailing Address - Phone:304-522-1550
Mailing Address - Fax:304-522-0704
Practice Address - Street 1:5221 US ROUTE 60 E
Practice Address - Street 2:RADIOLOGY, INC.
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2022
Practice Address - Country:US
Practice Address - Phone:304-522-1550
Practice Address - Fax:304-522-0704
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV66701363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV002011012OtherWV BCBS
KY52024290OtherPASSPORT
KY7100067710Medicaid
WVP00669815OtherRR MEDICARE (WV)
WV550493376 00OtherWV WORKER'S COMPENSATION
OH2926169Medicaid
KY7100067710Medicaid