Provider Demographics
NPI:1699483495
Name:COLLEY, MISTY JOY (FNP-BC)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:JOY
Last Name:COLLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 THORN ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-3560
Mailing Address - Country:US
Mailing Address - Phone:681-282-5609
Mailing Address - Fax:304-936-6157
Practice Address - Street 1:106 THORN ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-3560
Practice Address - Country:US
Practice Address - Phone:681-282-5609
Practice Address - Fax:304-936-6157
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV114784363LF0000X
VA0024185510363L00000X
TN36756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner