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Individual

MILISSA K SHORT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-BC

Contact information

Practice address
10003 WEBSTER ROAD, CAMDEN ON GAULEY, WV 26208-0069
(304) 226-5725
(304) 226-3274
Mailing address
10003 WEBSTER ROAD, CAMDEN ON GAULEY MEDICAL CENTER INC, CAMDEN ON GAULEY, WV 26208-0069
(304) 226-5725
(304) 226-3274

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
43219
WV
363LP2300X
Primary Care Nurse Practitioner
43219
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
43219
LICENSE
WV
Enumeration date
04/11/2008
Last updated
10/13/2020
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