Healthcare Provider Details

I. General information

NPI: 1194717603
Provider Name (Legal Business Name): JOY P FORD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOY P YOUNG

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5870 WEBSTER RD
SUMMERSVILLE WV
26651-9105
US

IV. Provider business mailing address

5870 WEBSTER RD
SUMMERSVILLE WV
26651-9105
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-3709
  • Fax:
Mailing address:
  • Phone: 304-872-3709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1020
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: