Provider Demographics
NPI:1972214534
Name:RICE, JUSTIN COLE (PA-C)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:COLE
Last Name:RICE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:WV
Mailing Address - Zip Code:26074-1082
Mailing Address - Country:US
Mailing Address - Phone:304-336-5098
Mailing Address - Fax:304-336-8868
Practice Address - Street 1:100 PADUCAH DR STE B
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-2710
Practice Address - Country:US
Practice Address - Phone:304-815-0050
Practice Address - Fax:304-815-0051
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant