Organization
HILLBILLY HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEONA FAY COOK DNP-C (DOCTORATE NURSE PRACTITIONER)
(304) 433-2229
Entity
Organization
Contact information
Practice address
12 QUASAR DR, MARTINSBURG, WV 25405-7706
(304) 839-3454
(304) 724-7399
Mailing address
PO BOX 726, KEARNEYSVILLE, WV 25430-0726
(304) 433-2229
(304) 724-7399
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568626174
NPI NUMBER FOR INDIVIDUAL TO BE LINKED TO THIS ACCOUNT
WV
01
—
1568626174
NPI
—
Enumeration date
05/11/2021
Last updated
10/18/2022
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