Anna C Stout-Tuckwiller, PA-C
Individual provider Active NPI Physician Assistant · Maxwelton, WV
NPI 1902199532 · NPPES record last updated May 3, 2022
Key facts
- NPI
- 1902199532
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 01554 (WV)
- Practice address
- 804 Industrial Park Rd
Maxwelton, WV 24957-8066 - Phone
- (304) 497-0500
- Fax
- (304) 497-0516
- NPI assigned
- May 16, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- 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 Inc
Practice addresses (Care Compare)
704 A 3Rd Ave
Marlinton, WV 24954-1142
Phone (888) 736-3229
PO Box
Suite 129
Maxwelton, WV 24957-0129
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130619000712 | WV | Practitioner - Physician Assistant | 7315186533 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01554 | WV | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Seneca Health Services, Inc. | Current | Accepting new patients | |
| Seneca Health Services Inc | Past | Accepting new patients |
Locations
704 3rd Ave
Marlinton, WV 24954
Phone (304) 799-6865
704 3rd Ave
#A
Marlinton, WV 24954
Phone (304) 799-6865
804 Industrial Park Rd
Ste 1
Maxwelton, WV 24957
Phone (304) 497-0500
804 Industrial Park Rd
Maxwelton, WV 24957
Phone (304) 497-0500
131 Wellness Dr
Summersville, WV 26651
Phone (304) 872-6503
180 Wellness Dr
Summersville, WV 26651
Phone (304) 872-0058
70 Parcoal Rd
Webster Springs, WV 26288
Phone (304) 847-5425
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 01554 | WV | Yes |
Addresses
Primary practice location
804 Industrial Park Rd
Maxwelton, WV 24957-8066
Mailing address
131 Wellness Dr
Summersville, WV 26651-5402
Phone (304) 872-6503
Other practice location 1
704 3rd Ave
Marlinton, WV 24954-1142
Phone (304) 799-6865
Other practice location 2
70 Parcoal Rd
Webster Springs, WV 26288-9767
Phone (304) 847-5425
Other practice location 3
131 Wellness Dr
Summersville, WV 26651-5402
Phone (304) 872-2659
Other practice location 4
414 Industrial Park Road
Maxwelton, WV 24957-0129
Phone (304) 497-2850
Other providers in Maxwelton, WV
- Vickie L Shuff
- Christina Sims
- Demmi Smallwood
- Melissa Dawn Smith
- Melissa Dawn Sparks
- Dorian Mekele Swann
- Charles David Taylor
- Lindsay F Taylor
- Mackenzie Emma Taylor
- Samantha Lynn Taylor
All providers in Maxwelton, WV · Physician Assistant 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 May 3, 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.