Active NPI
Mary Katherine Eller, APRN
- Family Nurse Practitioner
- Charleston, WV
National Provider Identifier
1346672011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 52349
- Practice address
- 6 Courtney Dr
Charleston, WV 25304-2696 - Phone
- (304) 720-9073
- Fax
- (304) 720-1921
- NPI assigned
- Aug 5, 2013
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 52349 | WV | Primary |
Addresses
Primary practice location
6 Courtney Dr
Charleston, WV 25304-2696
Mailing address
3712 Virginia Ave SE
Charleston, WV 25304-1506
Phone (304) 617-1490
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 |
|---|---|---|---|
| 52349 | WV | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375660800000",
"number": "1346672011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3712 VIRGINIA AVE SE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253041506",
"telephone_number": "304-617-1490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 COURTNEY DR",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253042696",
"telephone_number": "304-720-9073",
"fax_number": "304-720-1921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLER",
"first_name": "MARY",
"middle_name": "KATHERINE",
"name_prefix": "Mrs.",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-08-05",
"last_updated": "2013-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WV",
"license": "52349",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.