Provider Demographics
NPI:1851118012
Name:MYERS, PATRICIA ANN (VI)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:MYERS
Suffix:
Gender:F
Credentials:VI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 MCINTYRE RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25239-7087
Mailing Address - Country:US
Mailing Address - Phone:304-532-6876
Mailing Address - Fax:
Practice Address - Street 1:931 CANYON RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-0953
Practice Address - Country:US
Practice Address - Phone:304-532-6876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency