Provider Demographics
NPI:1285960856
Name:MURRINER, HOLLY R (PA-C)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:R
Last Name:MURRINER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 GREAT TEAYS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9816
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-201-5019
Practice Address - Street 1:116 HILLS PLZ
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25387
Practice Address - Country:US
Practice Address - Phone:304-720-4466
Practice Address - Fax:304-720-4821
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01324363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810016461Medicaid
WVWV1166AMedicare PIN
WV3810016461Medicaid
WV2032751Medicare PIN
WV2032752Medicare PIN
WVWV1166BMedicare PIN