Provider Demographics
NPI:1174621882
Name:MORRIS, MELINDA RAE (PA)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:RAE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:RAE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402-1150
Mailing Address - Country:US
Mailing Address - Phone:304-264-1000
Mailing Address - Fax:304-264-1374
Practice Address - Street 1:2500 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401
Practice Address - Country:US
Practice Address - Phone:304-264-1000
Practice Address - Fax:304-264-1374
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01132363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV01132OtherSTATE LICENSE #