Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Phoenix Rising Healthcare

Organization Primary Care Nurse Practitioner · NPI 1093284937

Phoenix Rising Healthcare is a Primary Care Nurse Practitioner in Fairmont, West Virginia. Registered with an NPI since 2018.

In the registry since
2018

Practice location Address checks out

5 Erwin Ln Ste A
Fairmont, WV 26554-1376
Phone: (304) 366-0111
Fax: (304) 366-2099
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X

Record details

NPI number1093284937
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Traci Tannehill — Managing Member Of Llc · (304) 366-0111
NPI enumeratedNovember 21, 2018
Last updated in NPPESOctober 15, 2020
Certification dateOctober 15, 2020
Mailing addressPo Box 1286, Fairmont, WV 26555-1286

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