Provider Demographics
NPI:1861024507
Name:SKAGGS, MICHAEL S (PMHNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:SKAGGS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CHURCH ST S STE 3
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-1666
Mailing Address - Country:US
Mailing Address - Phone:304-784-1962
Mailing Address - Fax:
Practice Address - Street 1:600 CHURCH ST S STE 3
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1666
Practice Address - Country:US
Practice Address - Phone:304-786-1222
Practice Address - Fax:304-786-1236
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2022151791363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
004369176OtherBCBS
WV1861024507Medicaid