Provider Demographics
NPI:1861604852
Name:SKAGGS, LAURA E (FNP-BC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:SKAGGS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 GREASY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-6900
Mailing Address - Country:US
Mailing Address - Phone:304-425-7615
Mailing Address - Fax:304-425-7635
Practice Address - Street 1:445 GIENOW RD
Practice Address - Street 2:
Practice Address - City:RURAL RETREAT
Practice Address - State:VA
Practice Address - Zip Code:24368-3210
Practice Address - Country:US
Practice Address - Phone:276-686-4007
Practice Address - Fax:276-686-4614
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV60314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30017455310002Medicaid