Provider Demographics
NPI:1356426423
Name:SKINNER, MELISSA BROOKE (PA-C)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:BROOKE
Last Name:SKINNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 WOODLYN DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-7304
Mailing Address - Country:US
Mailing Address - Phone:304-269-7364
Mailing Address - Fax:
Practice Address - Street 1:224 WOODLYN DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-7304
Practice Address - Country:US
Practice Address - Phone:304-269-7364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical