Organization
LITTLE BEAVER FAMILY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL L WHITE APRN (OWNER/PRESIDENT)
(304) 742-3570
Entity
Organization
Contact information
Practice address
16130 WEBSTER RD., CRAIGSVILLE, WV 26205-1728
(304) 742-3570
(304) 742-3572
Mailing address
PO BOX 1728, CRAIGSVILLE, WV 26205-1728
(304) 742-3570
(304) 742-3572
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
52802
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001784453
MTN STATE BCBS
WV
05
—
3810001807
—
WV
01
—
DE7201
RR MCARE
WV
Enumeration date
10/30/2006
Last updated
10/10/2012
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