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General NPI Number Information
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NPI Number | 1427668250
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Entity Type | Individual
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Provider Name | JARRET FAUST PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 1 RIVERSIDE CIR STE 300
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City | ROANOKE
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State | VA
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Zip | 24016-4962
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Country | US
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Telephone | 540-581-0170
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Fax | 479-966-4979
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Provider Business Mailing Address
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Address Line | 213 S JEFFERSON ST STE 1006
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City | ROANOKE
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State | VA
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Zip | 24011-1713
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Country | US
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Telephone | 540-224-5705
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Fax | 479-966-4979
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | PA-1175
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110009727
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License Number State | VA
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