Willow Creek Health Clinic Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

42727 Issued in WV

Legal business name

WILLOW CREEK HEALTH CLINIC INC

Practice address

15237 Coal Heritage Road/US-52 North
Honeycamp /247
Roderfield, WV 24881

Phone

(304) 436-8323

NPI assigned

Aug 29, 2016

Last updated

Aug 29, 2016By 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

Karen Patricia Addair, M.S.N, F.N.PNPI 1053543025

Title

President

Phone

(304) 436-8323

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 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

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.

• Karen P Addair, FNP-BC

  • Nurse Practitioner
  • Roderfield, WV
  • NPI 1053543025
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1472428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472428800000",
    "number": "1730635863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 219",
            "city": "PREMIER",
            "state": "WV",
            "postal_code": "248780219",
            "telephone_number": "304-436-8323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15237 COAL HERITAGE ROAD/US-52 NORTH",
            "address_2": "HONEYCAMP /247",
            "city": "RODERFIELD",
            "state": "WV",
            "postal_code": "24881",
            "telephone_number": "304-436-8323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CREEK HEALTH CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-29",
        "last_updated": "2016-08-29",
        "status": "A",
        "authorized_official_last_name": "ADDAIR",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-436-8323",
        "authorized_official_credential": "M.S.N, F.N.P"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WV",
            "license": "42727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen P Addair, FNP-BC
• Latosha Lavon Haywood

• Primary Care Clinic/Center in Roderfield, WV
• Providers in Roderfield, WV by specialty
• Primary Care Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.