Basic Information
| Provider Information | |||||||||
| NPI: | 1215030135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RATNAKAR | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2831 | ||||||||
| Address2: | WEST VIRGINIA GASTROENTEROLOGY & ENDOSCOPY | ||||||||
| City: | ELKINS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 262412831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046372360 | ||||||||
| FaxNumber: | 3046372362 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 CHENOWETH CREEK RD | ||||||||
| Address2: | |||||||||
| City: | ELKINS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 262419237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046372360 | ||||||||
| FaxNumber: | 3046372362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 04/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 00633 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 001763928 | 01 | WV | MOUNTAIN STATE BCBS | OTHER | WV633 | 01 | WV | HEALTH PLAN | OTHER |