Provider Demographics
NPI:1174922462
Name:CUMMINGS, SHELLY R (NP-C)
Entity type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:R
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 MEMORIAL CHURCH DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-1503
Mailing Address - Country:US
Mailing Address - Phone:304-292-7316
Mailing Address - Fax:304-599-8917
Practice Address - Street 1:6000 MEMORIAL CHURCH DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-1503
Practice Address - Country:US
Practice Address - Phone:304-292-7316
Practice Address - Fax:304-599-8917
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN70799-NP-C363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily