| Forefront Telecare Medical Services Pc | |
|
1627 Quarrier St Charleston WV 25311-2124 | |
| (972) 449-0540 | |
| (972) 449-0542 |
| Full Name | Forefront Telecare Medical Services Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1627 Quarrier St, Charleston, West Virginia |
| Authorized Official Name and Position | Sara Vitullo (DIRECTOR OF PAYER OPERATIONS) |
| Authorized Official Contact | 9724490540 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Forefront Telecare Medical Services Pc 1717 Main St Ste 5850 Dallas TX 75201-7317 Ph: (972) 449-0540 | Forefront Telecare Medical Services Pc 1627 Quarrier St Charleston WV 25311-2124 Ph: (972) 449-0540 |
| NPI Number | 1629698766 |
|---|---|
| Provider Enumeration Date | 04/18/2020 |
| Last Update Date | 07/23/2025 |
| Certification Date | 07/23/2025 |
| Medicare PECOS PAC ID | 0446668826 |
|---|---|
| Medicare Enrollment ID | O20210423001611 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629698766 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Carolyn Elizabeth King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477785392 PECOS PAC ID: 3072668615 Enrollment ID: I20230113001015 |
| Provider Name | Lloyd Ehigie Esene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013542158 PECOS PAC ID: 7911337910 Enrollment ID: I20230720000956 |
| Provider Name | Bryan Jaye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750707337 PECOS PAC ID: 9436374329 Enrollment ID: I20230907003657 |
| Provider Name | Blake Henchcliffe |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1982191409 PECOS PAC ID: 2062848617 Enrollment ID: I20231110000654 |
| Provider Name | Andrew Owens |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194168161 PECOS PAC ID: 5496051898 Enrollment ID: I20231130000672 |
| Provider Name | Elizabeth Umemba |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184276503 PECOS PAC ID: 6800208760 Enrollment ID: I20231223000014 |
| Provider Name | Rebecca Blackwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326607839 PECOS PAC ID: 9638506553 Enrollment ID: I20240402000135 |
| Provider Name | Olga Gonzalez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609275312 PECOS PAC ID: 7416176821 Enrollment ID: I20240405002000 |
| Provider Name | Hope Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922482587 PECOS PAC ID: 7315234382 Enrollment ID: I20240614002000 |
| Provider Name | Chastity Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588299291 PECOS PAC ID: 2961832878 Enrollment ID: I20240726000627 |
| Provider Name | Courtney Cox-kozel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992395958 PECOS PAC ID: 1759797186 Enrollment ID: I20240807003709 |
| Provider Name | Marsha Stapleton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497138887 PECOS PAC ID: 8123338803 Enrollment ID: I20241231000582 |
| Provider Name | Kettlyne Stcyr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427529759 PECOS PAC ID: 7618381682 Enrollment ID: I20250108000018 |
| Provider Name | Heather Warren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992202659 PECOS PAC ID: 7719237148 Enrollment ID: I20250207000714 |
| Provider Name | George King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760822084 PECOS PAC ID: 2961630496 Enrollment ID: I20250210003575 |
| Provider Name | Timothy Poquette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427613447 PECOS PAC ID: 9032446844 Enrollment ID: I20250327001160 |
| Provider Name | Thomas Rayner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1194008979 PECOS PAC ID: 0941533574 Enrollment ID: I20250327002703 |
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