MEDICARE: JESSICA A WOOD CFNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	55907	WV

General Provider Information

NPI Number	:	1558453480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA A WOOD CFNP

Provider Business Mailing Address
First Line	:	PO BOX 1615
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26507-1615
Country	:	US
Telephone Number	:	304-599-8802
Fax Number	:	304-599-5607

Provider Business Practice Location Address
First Line	:	2000 MON HEALTH MEDICAL PARK DRIVE
Second Line	:	SUITE 2300
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-0000
Country	:	US
Telephone Number	:	304-599-8802
Fax Number	:	304-599-5607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	04/05/2022

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