# FAYETTE CLINIC, PLLC

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

## Provider details

- **NPI number:** 1851580468
- **Authorized official:** MS. DARLENE NEWELL RN (OFFICE MANAGER)
- **Authorized official phone:** (304) 469-3334

## Contact information

- **Practice address:** 1 PHYSICIANS PLAZA, LOCHGELLY, WV 25866
- **Practice address phone:** (304) 469-3334
- **Mailing address:** 1 PHYSICIANS PLAZA, PO BOX 130, LOCHGELLY, WV 25866
- **Mailing address phone:** (304) 469-3334

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | WV | Yes |
| 363L00000X | Nurse Practitioner | — | WV | — |

## Other

- **Enumeration date:** 10/19/2007
- **Last updated:** 06/05/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 001708474 | BC/BS | WV |
| 05 | — | 0206041000 | — | WV |
| 05 | — | 0206041003 | — | WV |
| 01 | — | 200164 | FEDERAL BLACK LUNG | WV |
| 01 | — | 513906 | RURAL HEALTH PROVIDER \# | WV |