Provider Demographics
NPI:1538361621
Name:SKAGGS, HEIDI A (APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:SKAGGS
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:SCARBRO
Mailing Address - State:WV
Mailing Address - Zip Code:25917-0337
Mailing Address - Country:US
Mailing Address - Phone:304-469-2905
Mailing Address - Fax:304-469-2981
Practice Address - Street 1:59 GREYHOUND LANE
Practice Address - Street 2:
Practice Address - City:SMITHERS
Practice Address - State:WV
Practice Address - Zip Code:25186-0000
Practice Address - Country:US
Practice Address - Phone:304-981-4983
Practice Address - Fax:304-981-4949
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV62735363L00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005828Medicaid
WVWV4031AMedicare PIN