Provider Demographics
NPI:1972282689
Name:PAINE, KATIE (APRN,FNP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:PAINE
Suffix:
Gender:F
Credentials:APRN,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:26280-0247
Mailing Address - Country:US
Mailing Address - Phone:304-335-2050
Mailing Address - Fax:
Practice Address - Street 1:240 ALLEGHENY HWY
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-5749
Practice Address - Country:US
Practice Address - Phone:304-636-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV117106363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner