NPIMap

Individual provider Active NPI

Taylor Erin D'Etcheverry, PA-C

  • Physician Assistant
  • Charleston, WV
National Provider Identifier
1669943890
Registry record updated Aug 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110009282 Issued in VA
Practice address
3100 Maccorkle Ave SE Ste 101
Charleston, WV 25304-1215
Phone
(304) 388-5395
NPI assigned
Dec 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X 2268 WV
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 0110009282 VA Primary

Addresses

Primary practice location

3100 Maccorkle Ave SE Ste 101
Charleston, WV 25304-1215

Mailing address

3100 Maccorkle Ave SE Ste 101
Charleston, WV 25304-1215
Phone (304) 388-5395

Other practice location 1

20560 Southport Landing Pl
Smithfield, VA 23430-8116
Phone (757) 870-1865

Other practice location 2

1200 J D Anderson Dr
Morgantown, WV 26505-3494
Phone (304) 598-1996

Other practice location 3

600 Gresham Dr Ste 8630B
Norfolk, VA 23507-1904
Phone (757) 388-6115

Other names 1

  • Ms. Taylor E D'Etcheverry Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191114000108 WV Practitioner - Physician Assistant 1759713605 Reassigns benefits to 2 organizations
I20240314001293 VA Practitioner - Physician Assistant 1759713605 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charleston Area Medical Center IncGroup PAC ID 3375441637, 969 clinicians

Practice addresses (Care Compare)

3200 Maccorkle Ave SE
Charleston, WV 25304-1227
Phone (304) 388-5432

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-5432

Hospital & facility affiliations

  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2268WVMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Monongalia County General Hospital Company CurrentSince Sep 22, 2025 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Mar 1, 2025 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Mar 1, 2025 Accepting new patients
Sentara Medical Group CurrentSince Jan 1, 2024 Accepting new patients
Monongalia County General Hospital Company Past Accepting new patients
Windber Hospital, Inc. Past Accepting new patients

Locations

600 Gresham Dr
#8600
Norfolk, VA 23507
Phone (757) 388-6005

600 Gresham Dr
Ste 8630B
Norfolk, VA 23507
Phone (757) 338-6115

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

3100 Maccorkle Ave SE
Ste 101
Charleston, WV 25304
Phone (304) 388-5395

400 Association Dr
Ste 102
Charleston, WV 25311
Phone (304) 388-1762

150 Memorial Dr
Kingwood, WV 26537
Phone (304) 329-4701

1200 J D Anderson Dr
Morgantown, WV 26505
Phone (304) 598-1460

2000 Mon Health Medical Park Dr
Ste 2300
Morgantown, WV 26505
Phone (304) 599-8802

Interoperability endpoints

  • Direct secure messaging: tdetcheverry868470@direct.sentara.net

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754611200000",
    "number": "1669943890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 MACCORKLE AVE SE STE 101",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041215",
            "telephone_number": "304-388-5395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 MACCORKLE AVE SE STE 101",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041215",
            "telephone_number": "304-388-5395"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20560 Southport Landing Pl",
            "address_purpose": "LOCATION",
            "city": "Smithfield",
            "state": "VA",
            "postal_code": "234308116",
            "country_code": "US",
            "telephone_number": "757-870-1865",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 J D Anderson Dr",
            "address_purpose": "LOCATION",
            "city": "Morgantown",
            "state": "WV",
            "postal_code": "265053494",
            "country_code": "US",
            "telephone_number": "304-598-1996",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "600 Gresham Dr Ste 8630B",
            "address_purpose": "LOCATION",
            "city": "Norfolk",
            "state": "VA",
            "postal_code": "235071904",
            "country_code": "US",
            "telephone_number": "757-388-6115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "D'ETCHEVERRY",
        "first_name": "TAYLOR",
        "middle_name": "ERIN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-16",
        "last_updated": "2025-08-08",
        "certification_date": "2025-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "WV",
            "license": "2268",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110009282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAYLOR",
            "last_name": "D'ETCHEVERRY",
            "middle_name": "E",
            "prefix": "MS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.