NPIMap

Organization Active NPI

Phoenix Rising Healthcare

  • Primary Care Nurse Practitioner
  • Fairmont, WV
National Provider Identifier
1093284937
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
PHOENIX RISING HEALTHCARE
Practice address
5 Erwin LN Ste a
Fairmont, WV 26554-1376
Phone
(304) 366-0111
Fax
(304) 366-2099
NPI assigned
Nov 21, 2018
Last updated
Oct 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Traci Tannehill, APRNNPI 1881021459
Title
Managing Member of LLC
Phone
(304) 366-0111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X NU Primary

Addresses

Primary practice location

5 Erwin LN Ste a
Fairmont, WV 26554-1376

Mailing address

PO Box 1286
Fairmont, WV 26555-1286
Phone (304) 366-0111

National Provider Directory

National Provider Directory

Locations

5 Erwin Ln
Ste A
Fairmont, WV 26554
Phone (304) 366-0111

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1542758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1093284937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1286",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265551286",
            "telephone_number": "304-366-0111",
            "fax_number": "304-366-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 ERWIN LN STE A",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265541376",
            "telephone_number": "304-366-0111",
            "fax_number": "304-366-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX RISING HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-21",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "TANNEHILL",
        "authorized_official_first_name": "TRACI",
        "authorized_official_title_or_position": "MANAGING MEMBER OF LLC",
        "authorized_official_telephone_number": "304-366-0111",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairmont, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.