Healthcare Provider Details

I. General information

NPI: 1487858775
Provider Name (Legal Business Name): JENNY LYNN CROSS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 GORMAN AVE SUITE 2
ELKINS WV
26241-3082
US

IV. Provider business mailing address

911 GORMAN AVE
ELKINS WV
26241-3082
US

V. Phone/Fax

Practice location:
  • Phone: 304-637-6302
  • Fax: 304-637-6307
Mailing address:
  • Phone: 304-637-6302
  • Fax: 304-637-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number21597
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number21597
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: