Coal River Primary Care and Wellness Center LLC
Organization Active NPI Family Nurse Practitioner · Nellis, WV
NPI 1487284451 · NPPES record last updated Apr 5, 2022
Key facts
- NPI
- 1487284451
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- COAL RIVER PRIMARY CARE AND WELLNESS CENTER LLC
- Practice address
- 62 Fork Creek Rd
Nellis, WV 25142-9737 - Phone
- (304) 833-0815
- Fax
- (304) 833-0030
- NPI assigned
- Jan 18, 2020
- Organization subpart
- No
Authorized official
- Name
- Rebecca Ruby Barker, FNP
- Title
- Sole Owner; FNP-BC
- Phone
- (304) 833-0815
Practitioners 1
-
Rebecca Ruby Barker, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200402001856 | WV | Part B Supplier - Clinic/Group Practice | 0042649642 |
Receives reassigned benefits from 1 practitioner Practice locations: Nellis, WV |
National Provider Directory
Locations
62 Fork Creek Rd
Nellis, WV 25142
Phone (304) 369-1230
179 Memorial Dr
Ste 100
Nellis, WV 25142
Phone (304) 986-4486
Interoperability endpoints
- https://api.platform.athenahealth.com/21052/brand/1/csg/1/fhir/r4
- rebecca.barker.1@21052.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Family Nurse Practitioner |
363LF0000X | Yes | ||
| Family Health Clinical Nurse Specialist |
364SF0001X |
Addresses
Primary practice location
62 Fork Creek Rd
Nellis, WV 25142-9737
Mailing address
62 Fork Creek Rd
Nellis, WV 25142-9737
Phone (304) 833-0815
Other names
- Coal River Primary
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rebecca.barker.1@21052.direct.athenahealth.com |
Other providers in Nellis, WV
- Rebecca Ruby Barker
- Boone Memorial Hospital, Inc
- Cheyeanna Dawn Buckner
- Jeremy Scott Hall
- Shannon Pauley
- Pamela D Shorkey
- Sandra A Stepp
All providers in Nellis, WV · Family Nurse Practitioner in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 5, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.