Individual
ANITA LOUISE CALLICOAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
3501 MACCORKLE AVE SE # 151, CHARLESTON, WV 25304-1419
(866) 460-3567
Mailing address
105 OAKWOOD ESTS, SCOTT DEPOT, WV 25560-9730
(304) 610-7488
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
59045
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208017790
UMWA
WV
01
—
20801779000
WV WORKERS COMP
WV
05
—
2821307
—
OH
05
—
3810006599
—
WV
01
—
613154600
BLACL LUNG
WV
01
—
P00720801
RAILROAD
—
Enumeration date
08/28/2006
Last updated
05/30/2013
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