Provider Demographics
NPI:1598367187
Name:AMMONS, CAROLINE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:AMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 BROOKOVER RUN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:WV
Mailing Address - Zip Code:26570-6035
Mailing Address - Country:US
Mailing Address - Phone:304-319-3123
Mailing Address - Fax:
Practice Address - Street 1:196 BROOKOVER RUN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:WV
Practice Address - Zip Code:26570-6035
Practice Address - Country:US
Practice Address - Phone:304-319-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant