Provider Demographics
NPI:1891513362
Name:PRICHARD, WILLIAM DALE
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DALE
Last Name:PRICHARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CHIPMUNK TRAIL
Mailing Address - Street 2:
Mailing Address - City:PEACH CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:59 CHIPMUNK TRAIL
Practice Address - Street 2:
Practice Address - City:PEACH CREEK
Practice Address - State:WV
Practice Address - Zip Code:25639
Practice Address - Country:US
Practice Address - Phone:304-733-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant