Delta Lifestyle Solutions

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

DELTA LIFESTYLE SOLUTIONS

Practice address

109 Tolley Dr
Bridgeport, WV 26330-1669

Phone

(304) 623-6300

Fax

(304) 623-6302

NPI assigned

Nov 10, 2020

Last updated

Nov 5, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary Hackney, FNP-BCNPI 1639326747

Title

Owner

Phone

(304) 623-6300

Specialties & licenses 2

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

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.

• Mary Elizabeth Hackney, FNP-BC

  • Family Nurse Practitioner
  • Buckhannon, WV
  • NPI 1639326747
  NPD Authorized official
• Dawn M Colley, LSW

  • Counselor
  • Bridgeport, WV
  • NPI 1609402510
  NPD (past)
• Karla Kay Rinehart, WV-LSW, B.S.

  • Social Worker
  • Bridgeport, WV
  • NPI 1184079642
  NPD (past)
• Andrea Kae Simmons, LCSW

  • Clinical Social Worker
  • Hambleton, WV
  • NPI 1023507605
  NPD (past)

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

{
    "created_epoch": "1604966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636070400000",
    "number": "1619579208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4246",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263024246",
            "telephone_number": "304-623-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 TOLLEY DR",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301669",
            "telephone_number": "304-623-6300",
            "fax_number": "304-623-6302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA LIFESTYLE SOLUTIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-10",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A",
        "authorized_official_last_name": "HACKNEY",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-623-6300",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639326747",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dipanjan Debnath, MD
• Justin Daniel Debusca, CRNA
• Josandra Defazio, LGSW
• Dino James Delaportas, M.D.
• Ronalene Holt Delligatti, MSW, LGSW
• James J Demarco, MD
• Zane A Dennison, DO
• Dermatology Outreach, LLC
• Emily Devereux, OT
• Angela M Dewees, LHIS

• Family Medicine Physician in Bridgeport, WV
• Providers in Bridgeport, WV by specialty
• Family Medicine Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.