Provider Demographics
NPI:1528609856
Name:NIEVES, JAN AUGUSTA (PMHNP-BC (APRN))
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:AUGUSTA
Last Name:NIEVES
Suffix:
Gender:F
Credentials:PMHNP-BC (APRN)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2067
Mailing Address - Country:US
Mailing Address - Phone:443-333-3996
Mailing Address - Fax:
Practice Address - Street 1:3094 CHARLESTOWN ROAD
Practice Address - Street 2:
Practice Address - City:KEARNEYSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25430
Practice Address - Country:US
Practice Address - Phone:304-901-2070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104701363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health