Provider Demographics
NPI:1679755409
Name:GARVIN, SHIRLEY KAY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:KAY
Last Name:GARVIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:KAY
Other - Last Name:MYERS GARVIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:417 GRAND PARK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4049
Mailing Address - Country:US
Mailing Address - Phone:304-485-2700
Mailing Address - Fax:304-422-1861
Practice Address - Street 1:517 36TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-1006
Practice Address - Country:US
Practice Address - Phone:304-485-1044
Practice Address - Fax:304-422-1861
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00568363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical