Healthcare Provider Details

I. General information

NPI: 1376490086
Provider Name (Legal Business Name): KENNETH JARRELL PRSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 N FRONT ST
WHEELING WV
26003-2385
US

IV. Provider business mailing address

87 15TH ST
WHEELING WV
26003-3548
US

V. Phone/Fax

Practice location:
  • Phone: 304-650-6732
  • Fax:
Mailing address:
  • Phone: 304-650-6732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: