Summersville Skin Care Center Inc

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

44396 Issued in WV

Legal business name

SUMMERSVILLE SKIN CARE CENTER INC

Practice address

818 Arbuckle Rd
Summersville, WV 26651-1704

Phone

(304) 872-3654

NPI assigned

Nov 28, 2006

Organization subpart

No

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

Authorized official

Name

Delores A Lucky, RNC-FNPNPI 1528174331

Title

Nurse Practitioner

Phone

(304) 872-3654

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Locations

Practitioners 1

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.

• Delores A Lucky, C-FNP

  • Nurse Practitioner
  • Summersville, WV
  • NPI 1528174331
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311206400000",
    "number": "1346316395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "818 ARBUCKLE RD",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266511704",
            "telephone_number": "304-872-3654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 ARBUCKLE RD",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266511704",
            "telephone_number": "304-872-3654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERSVILLE SKIN CARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2011-07-21",
        "status": "A",
        "authorized_official_last_name": "LUCKY",
        "authorized_official_first_name": "DELORES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "304-872-3654",
        "authorized_official_credential": "RNC-FNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "WV",
            "license": "44396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Summersville Regional Medical Center
• Summersville Regional Medical Center
• Summersville Regional Medical Center
• Summersville Regional Medical Center (SMH Pharmacy)
• Summersville Regional Medical Center
• Summersville SNF LLC (Summersville Rehab & Nursing Center)
• Summersville Urology Associates, Inc. (David F. Meriwether, MD)
• Vincent Sweeney
• Stacey Michele Sweet, LPN
• Wendy Crystal Talbert

• Nurse Practitioner in Summersville, WV
• Providers in Summersville, WV by specialty
• Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.