# BRUCETON FAMILY MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295228161
- **Authorized official:** MRS. ALYSIA FUNK APRN,FNP-BC (OWNER/NURSE PRACTITIONER)
- **Authorized official phone:** (304) 379-7600

## Contact information

- **Practice address:** 198 MORGANTOWN ST STE 2, BRUCETON MILLS, WV 26525
- **Practice address phone:** (304) 379-7600
- **Practice address fax:** (304) 379-7599
- **Mailing address:** PO BOX 442, BRUCETON MILLS, WV 26525-0442
- **Mailing address phone:** (304) 379-7600
- **Mailing address fax:** (304) 379-7599

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 52464 | WV | Yes |
| 207Q00000X | Family Medicine Physician | 81124 | WV | — |

## Other

- **Enumeration date:** 06/14/2018
- **Last updated:** 07/05/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3810029631 | — | WV |