# AGNES A ENRICO-SIMON, PLLC

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

## Provider details

- **NPI number:** 1386846707
- **Authorized official:** AGNES A ENRICO-SIMON MD (PHYSICIAN)
- **Authorized official phone:** (304) 675-6817

## Contact information

- **Practice address:** 2415 JACKSON AVE, PT PLEASANT, WV 25550-2042
- **Practice address phone:** (304) 675-6090
- **Practice address fax:** (304) 675-5893
- **Mailing address:** 2415 JACKSON AVE, PT PLEASANT, WV 25550-2042
- **Mailing address phone:** (304) 675-6090
- **Mailing address fax:** (304) 675-5893

## Taxonomy

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

## Other

- **Enumeration date:** 06/05/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3002914000 | — | WV |