Individual
ADAM THOMAS FANNIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, MHA, APRN-CNP
Contact information
Practice address
3100 MACCORKLE AVE SE STE 205, CHARLESTON, WV 25304-1228
(740) 395-6011
Mailing address
3417 VIRGINIA AVE SE, CHARLESTON, WV 25304-1308
(740) 395-6011
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
108310
WV
363L00000X
Nurse Practitioner
108310
WV
Other
Enumeration date
07/25/2025
Last updated
10/27/2025
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