Active NPI
Ravenlou Wamsley
- Peer Specialist
- Logan, WV
National Provider Identifier
1134845373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 22-9154
- Practice address
- 174 Lmah Center Rd
Logan, WV 25601-4058 - Phone
- (304) 792-7130
- Fax
- (304) 896-5184
- NPI assigned
- Oct 19, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 22-9154 | WV | Primary |
Addresses
Primary practice location
174 Lmah Center Rd
Logan, WV 25601-4058
Mailing address
PO Box 176
Logan, WV 25601-0176
Phone (304) 792-7130
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22-9154 | Other | WV | WV CERTIFICATION BOARD FOR ADDICTION AND PREVENTION PROFESSIONALS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22-9154 | WV | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666137600000",
"number": "1134845373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 176",
"city": "LOGAN",
"state": "WV",
"postal_code": "256010176",
"telephone_number": "304-792-7130",
"fax_number": "304-896-5184"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "174 LMAH CENTER RD",
"city": "LOGAN",
"state": "WV",
"postal_code": "256014058",
"telephone_number": "304-792-7130",
"fax_number": "304-896-5184"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAMSLEY",
"first_name": "RAVENLOU",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-19",
"last_updated": "2022-10-19",
"certification_date": "2022-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "WV",
"license": "22-9154",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WV CERTIFICATION BOARD FOR ADDICTION AND PREVENTION PROFESSIONALS",
"identifier": "22-9154",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Logan, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.