Healthcare Provider Details

I. General information

NPI: 1144300773
Provider Name (Legal Business Name): JENNIE LEE YOOST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR STE 4500
HUNTINGTON WV
25701-3655
US

IV. Provider business mailing address

1600 MEDICAL CENTER DR SUITE 4500
HUNTINGTON WV
25701-3656
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1400
  • Fax:
Mailing address:
  • Phone: 304-691-1400
  • Fax: 304-691-1453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number43253
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25105
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: