Provider Demographics
NPI:1851489157
Name:PUCKETT, FRANKIE A (MD)
Entity type:Individual
Prefix:DR
First Name:FRANKIE
Middle Name:A
Last Name:PUCKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 DIANA DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:26288-9078
Mailing Address - Country:US
Mailing Address - Phone:304-847-5682
Mailing Address - Fax:
Practice Address - Street 1:125 DIANA DR
Practice Address - Street 2:
Practice Address - City:WEBSTER SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:26288-9078
Practice Address - Country:US
Practice Address - Phone:304-847-5682
Practice Address - Fax:304-847-5985
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22820208600000X, 207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018033Medicaid
WV4297231Medicare PIN