Healthcare Provider Details

I. General information

NPI: 1386563724
Provider Name (Legal Business Name): JACOB ALLEN RICHARDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SCOTT AVE
MORGANTOWN WV
26508-8804
US

IV. Provider business mailing address

301 SCOTT AVE
MORGANTOWN WV
26508-8804
US

V. Phone/Fax

Practice location:
  • Phone: 304-296-1731
  • Fax: 304-225-2288
Mailing address:
  • Phone: 304-296-1731
  • Fax: 304-225-2288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: