Provider Demographics
NPI:1871533182
Name:FELL, ALAN THOMAS (CRNA)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:THOMAS
Last Name:FELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-0665
Mailing Address - Country:US
Mailing Address - Phone:304-469-3918
Mailing Address - Fax:
Practice Address - Street 1:430 MAIN ST
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901
Practice Address - Country:US
Practice Address - Phone:304-469-8616
Practice Address - Fax:304-929-2461
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV37929367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0066807-000Medicaid
WVFE7247612Medicare PIN
WV0066807-000Medicaid