Provider Demographics
NPI:1558180091
Name:YOKUM, CONNIE SUE (FNP)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:YOKUM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 LAVALETTE AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3020
Mailing Address - Country:US
Mailing Address - Phone:304-614-8320
Mailing Address - Fax:
Practice Address - Street 1:700 CHAPPELL RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2704
Practice Address - Country:US
Practice Address - Phone:304-644-0504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV120488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily