| Coal River Primary | |
|
62 Fork Creek Rd Nellis WV 25142-9737 | |
| (304) 833-0815 | |
| (304) 833-0030 |
| Full Name | Coal River Primary |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 62 Fork Creek Rd, Nellis, West Virginia |
| Authorized Official Name and Position | Rebecca Ruby Barker (SOLE OWNER; FNP-BC) |
| Authorized Official Contact | 3048330815 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coal River Primary 62 Fork Creek Rd Nellis WV 25142-9737 Ph: (304) 833-0815 | Coal River Primary 62 Fork Creek Rd Nellis WV 25142-9737 Ph: (304) 833-0815 |
| NPI Number | 1487284451 |
|---|---|
| Provider Enumeration Date | 01/18/2020 |
| Last Update Date | 04/05/2022 |
| Certification Date | 04/05/2022 |
| Medicare PECOS PAC ID | 0042649642 |
|---|---|
| Medicare Enrollment ID | O20200402001856 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487284451 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 363LF0000X | Nurse Practitioner - Family | () | Primary |
| 364SF0001X | Clinical Nurse Specialist - Family Health | () | Secondary |
| Provider Name | Rebecca Ruby Barker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134472525 PECOS PAC ID: 6608012307 Enrollment ID: I20130425000355 |
Bmh Nellis Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 62 Fork Creek Rd, Nellis, WV 25142 Phone: 304-369-1230 Fax: 304-369-6036 |