Healthcare Provider Details

I. General information

NPI: 1962891085
Provider Name (Legal Business Name): JESSICA MICHELLE GOLD NTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 JONES AVE
OAK HILL WV
25901-2908
US

IV. Provider business mailing address

325 JONES AVE
OAK HILL WV
25901-2908
US

V. Phone/Fax

Practice location:
  • Phone: 678-200-5953
  • Fax: 304-465-4325
Mailing address:
  • Phone: 678-200-5953
  • Fax: 304-465-4325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: