Individual
ANN LOUISE NICELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
60 ROXBURY RD, WHITEHALL MEDICAL, PLLC, FAIRMONT, WV 26554-8223
(304) 363-6600
(304) 363-7700
Mailing address
60 ROXBURY RD, WHITEHALL MEDICAL, PLLC, FAIRMONT, WV 26554-8223
(304) 363-6600
(304) 363-7700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
00375
WV
363A00000X
Physician Assistant
Primary
464
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00455326
RR MEDICARE
WV
01
—
S99643
WV WORKER'S COMP
WV
Enumeration date
01/25/2007
Last updated
05/06/2009
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