Healthcare Provider Details

I. General information

NPI: 1801634084
Provider Name (Legal Business Name): JESSICA HUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 HARRISON AVE STE A12
ELKINS WV
26241-3356
US

IV. Provider business mailing address

1111 VAN VOORHIS RD STE 2
MORGANTOWN WV
26505-2737
US

V. Phone/Fax

Practice location:
  • Phone: 304-553-7063
  • Fax: 304-591-1038
Mailing address:
  • Phone: 304-598-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number37475
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: