1. Home
  2. Directory
  3. West Virginia
  4. Princeton
  5. Pediatrics
  6. NPI Profile
Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

LIVELY PEDIATRICS, PLLC
NPI 1063006047
Pediatrics in Princeton, WV

Active since February 21, 2021CLIA 51D2216950 · Waiver
466 COURTHOUSE RD, PRINCETON, WV 24740(304) 913-3160(855) 618-2212 Get Directions Write a Review

NPPES record last updated: September 22, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 22, 2026, May 10, 2021, Mar 25, 2021 and 1 more (4 updates tracked since 2021).

About Lively Pediatrics, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LIVELY PEDIATRICS, PLLC (NPI 1063006047) is a healthcare organization registered as a pediatrics in Princeton, West Virginia and active in the NPI registry since February 2021. The organization holds a CLIA Waiver certificate valid through March 16, 2027 and lists Ryan Mitchell, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1063006047
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameLIVELY PEDIATRICS, PLLC
Location Address466 COURTHOUSE RDPrinceton, WV 24740-2422
Mailing Address466 Courthouse RdPrinceton, WV 24740-2422 · (304) 913-3160 · Fax (855) 618-2212
Phone(304) 913-3160
Fax(855) 618-2212
Organization SubpartNo
Authorized OfficialRyan MitchellOffice Manager · (304) 952-2087
Enumeration DateFebruary 21, 2021
Last NPPES UpdateSeptember 22, 20264 updates tracked since enumeration
NPPES CertifiedSeptember 22, 2026
✔ NPI 1063006047 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
466 COURTHOUSE RD, Princeton, WV 24740
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Highmark Blue Cross Blue Shield West Virginia.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Lively Pediatrics, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Lively Pediatrics, PLLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Tara Mitchell, D.O.
Pediatric Medicine
NPI 1326221888
466 COURTHOUSE RD
Princeton, WV 24740
(304) 913-3160
✔ PECOSSame address
Jennifer Taylor, FNP-BC
Nurse Practitioner
NPI 1851918494
435 MEATSHOP ROAD
Spanishburg, WV 25922
(304) 920-0024
✔ PECOS6.9 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 51D2216950

Lively Pediatrics, PLLC · Princeton, WV
Active · expires Mar 16, 2027
CLIA Number51D2216950
Laboratory TypePhysician Office
Certificate Effective DateMarch 17, 2025
Certificate Expiration DateMarch 16, 2027
Laboratory DirectorDr. Tara L. Mitchell
Laboratory Phone(304) 952-2087
Laboratory LocationLively Pediatrics, PLLC466 Courthouse Road, Princeton, WV 24740
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lively Pediatrics, PLLC's NPI number?

The NPI number for Lively Pediatrics, PLLC is 1063006047. It was assigned to this organization in the NPPES registry on February 21, 2021.

Where is Lively Pediatrics, PLLC located?

Lively Pediatrics, PLLC is located at 466 Courthouse Rd, Princeton, WV 24740. The listed phone number is (304) 913-3160.

What is Lively Pediatrics, PLLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Lively Pediatrics, PLLC enrolled in Medicare?

Yes. Lively Pediatrics, PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Lively Pediatrics, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Lively Pediatrics, PLLC, in Nurse Practitioner and Pediatric Medicine. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Lively Pediatrics, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 51D2216950) is associated with this NPI, valid through March 16, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Lively Pediatrics, PLLC accept?

Health plans from Highmark Blue Cross Blue Shield West Virginia list Lively Pediatrics, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lively Pediatrics, PLLC was last updated on September 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 33 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.