1205883477 NPI number — JESSICA FAE WOY GOULD PA-C

Table of content: JESSICA FAE WOY GOULD PA-C (NPI 1205883477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205883477 NPI number — JESSICA FAE WOY GOULD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOY GOULD
Provider First Name:
JESSICA
Provider Middle Name:
FAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOY
Provider Other First Name:
JESSICA
Provider Other Middle Name:
FAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205883477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 944
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEYSER
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26726-0944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-788-6462
Provider Business Mailing Address Fax Number:
304-788-6555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
RR 3 BOX 3267
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEYSER
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26726-9422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-788-6462
Provider Business Practice Location Address Fax Number:
304-788-6555
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01035 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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