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General NPI Number Information
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NPI Number | 1033597422
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Entity Type | Individual
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Provider Name | JESSICA AMOS D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/18/2015
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 3200 MACCORKLE AVE SE ROBERT C. BYRD CLINICAL TRAINING CENTER, 4TH FLOOR
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City | CHARLESTON
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State | WV
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Zip | 25304
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Country | US
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Telephone | 304-388-5590
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Fax | 304-388-8238
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Provider Business Mailing Address
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Address Line | 3200 MACCORKLE AVE SE ROBERT C. BYRD CLINICAL TRAINING CENTER, 4TH FLOOR
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City | CHARLESTON
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State | WV
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Zip | 25304-1227
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Country | US
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Telephone | 304-388-5590
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Fax | 304-388-8238
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 3346
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License Number State | WV
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