Healthcare Provider Details

I. General information

NPI: 1316593270
Provider Name (Legal Business Name): JESSICA TOATH-CALLAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5161 WASHINGTON ST W
CROSS LANES WV
25313-1535
US

IV. Provider business mailing address

438 RIVIERA RD
MOUNT NEBO WV
26679-8264
US

V. Phone/Fax

Practice location:
  • Phone: 304-722-7600
  • Fax:
Mailing address:
  • Phone: 304-872-4222
  • Fax: 304-369-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number102548
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: