Basic Information
| Provider Information | |||||||||
| NPI: | 1033597422 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMOS | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 MACCORKLE AVE SE | ||||||||
| Address2: | ROBERT C. BYRD CLINICAL TRAINING CENTER, 4TH FLOOR | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043885590 | ||||||||
| FaxNumber: | 3043888238 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 MACCORKLE AVE SE | ||||||||
| Address2: | ROBERT C. BYRD CLINICAL TRAINING CENTER, 4TH FLOOR | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043885590 | ||||||||
| FaxNumber: | 3043888238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2015 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 3346 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.