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General NPI Number Information
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NPI Number | 1205883477
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Entity Type | Individual
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Provider Name | JESSICA FAE WOY GOULD PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | RR 3 BOX 3267
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City | KEYSER
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State | WV
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Zip | 26726-9422
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Country | US
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Telephone | 304-788-6462
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Fax | 304-788-6555
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Provider Business Mailing Address
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Address Line | PO BOX 944
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City | KEYSER
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State | WV
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Zip | 26726-0944
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Country | US
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Telephone | 304-788-6462
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Fax | 304-788-6555
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01035
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License Number State | WV
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