NPIMap

Individual provider Active NPI

Keisha R Saunders, FNP-BC

  • Family Nurse Practitioner
  • Gary, WV
National Provider Identifier
1942559364
Registry record updated Dec 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71622 Issued in WV
Practice address
RR 103 Supply Street
Gary, WV 24836-0507
Phone
(304) 448-2101
Fax
(304) 448-3217
NPI assigned
Aug 30, 2012
Last updated
Dec 14, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71622 WV Primary

Addresses

Primary practice location

RR 103 Supply Street
Gary, WV 24836-0507

Mailing address

133 Hundley St
Apt. 2
Princeton, WV 24740-2489
Phone (304) 320-7595

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121008000059 WV Practitioner - Nurse Practitioner 1052560018 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tug River Health Association, IncGroup PAC ID 7214820547, shared by 6 NPIs, 14 clinicians

Practice addresses (Care Compare)

512 Mountaineer Hwy
RM 1344
Bradshaw, WV 24817
Phone (304) 967-7682

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tug River Health Association, Inc CurrentSince Aug 11, 2012 Accepting new patients
Tug River Health Association, Inc. CurrentSince Feb 13, 2020 Accepting new patients
Tug River Health Association, Inc CurrentSince Mar 27, 2024 Accepting new patients
Tug River Health Association, Inc CurrentSince Aug 11, 2012 Accepting new patients
Tug River Health Association, Inc Past Accepting new patients

Locations

200 12th Street Ext
Princeton, WV 24740
Phone (304) 425-1711

1880 Mount View Rd
Ste 500
Welch, WV 24801
Phone (304) 436-4798

Interoperability endpoints

  • Direct secure messaging: keisha.saunders.1@18068.direct.athenahealth.com

Organizations & group practices 8

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.

Hospital & facility affiliations 3

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": "1346284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355443200000",
    "number": "1942559364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 HUNDLEY ST",
            "address_2": "APT. 2",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "247402489",
            "telephone_number": "304-320-7595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "RR 103 SUPPLY STREET",
            "city": "GARY",
            "state": "WV",
            "postal_code": "248360507",
            "telephone_number": "304-448-2101",
            "fax_number": "304-448-3217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAUNDERS",
        "first_name": "KEISHA",
        "middle_name": "R",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-30",
        "last_updated": "2012-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "71622",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gary, WV

Sources for this page

Verify at the official NPI Registry.