Anna C Stout-Tuckwiller, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

01554 Issued in WV

Practice address

804 Industrial Park Rd
Maxwelton, WV 24957-8066

Phone

(304) 497-0500

Fax

(304) 497-0516

NPI assigned

May 16, 2011

Last updated

May 3, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Seneca Health Services IncGroup PAC ID 8022005263, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Seneca Health Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Maxwelton, WV
  • NPI 1154532513
  Medicare reassignment Care Compare group
• Seneca Health Services, Inc.

  • Family Medicine Physician
  • Maxwelton, WV
  • NPI 1235838954
  NPD
• Seneca Health Services Inc

  • Community/Behavioral Health Agency
  • Maxwelton, WV
  • NPI 1245441609
  NPD (past)

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

{
    "created_epoch": "1305504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1902199532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 WELLNESS DR",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266515402",
            "telephone_number": "304-872-6503",
            "fax_number": "304-872-5415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 INDUSTRIAL PARK RD",
            "city": "MAXWELTON",
            "state": "WV",
            "postal_code": "249578066",
            "telephone_number": "304-497-0500",
            "fax_number": "304-497-0516"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "704 3rd Ave",
            "address_purpose": "LOCATION",
            "city": "Marlinton",
            "state": "WV",
            "postal_code": "249541142",
            "country_code": "US",
            "telephone_number": "304-799-6865",
            "fax_number": "304-799-6878",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "131 Wellness Dr",
            "address_purpose": "LOCATION",
            "city": "Summersville",
            "state": "WV",
            "postal_code": "266515402",
            "country_code": "US",
            "telephone_number": "304-872-2659",
            "fax_number": "304-872-1685",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "414 Industrial Park Road",
            "address_purpose": "LOCATION",
            "city": "Maxwelton",
            "state": "WV",
            "postal_code": "249570129",
            "country_code": "US",
            "telephone_number": "304-497-2850",
            "fax_number": "304-497-2805",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "70 Parcoal Rd",
            "address_purpose": "LOCATION",
            "city": "Webster Springs",
            "state": "WV",
            "postal_code": "262889767",
            "country_code": "US",
            "telephone_number": "304-847-5425",
            "fax_number": "304-547-5422",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOUT-TUCKWILLER",
        "first_name": "ANNA",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-16",
        "last_updated": "2022-05-03",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "01554",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vickie L Shuff, LGSW
• Christina Sims
• Demmi Smallwood, RDH
• Melissa Dawn Smith, PRSS, CASE MANAGER
• Melissa Dawn Sparks, B.S. QMHP CM
• Dorian Mekele Swann
• Charles David Taylor, BA
• Lindsay F Taylor, PHARM.D.
• Mackenzie Emma Taylor, MSW
• Samantha Lynn Taylor, MSW, LGSW

• Physician Assistant in Maxwelton, WV
• Providers in Maxwelton, WV by specialty
• Physician Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.