Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 30616 | WV |
N | 208600000X | Surgeon | 30616 | WV |
N | 208200000X | Surgeon | BP10043382 | TX |
N | 208600000X | Surgeon | BP10043382 | TX |
Y | 2086X0206X | Surgical Oncologist | 30616 | WV |
NPI | 1154682169 |
---|---|
Provider Name | Yana Puckett |
First Address | Charleston, WV 25304-1230 |
Second Address | Charleston, WV 25304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2012 |
Last Update Date | 10/08/2021 |