Provider Demographics
NPI:1164593265
Name:WIEST, JEANIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANIE
Middle Name:A
Last Name:WIEST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MOUNT VISTA DR
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-9402
Mailing Address - Country:US
Mailing Address - Phone:304-472-4427
Mailing Address - Fax:304-472-4474
Practice Address - Street 1:20 MOUNT VISTA DR
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-9402
Practice Address - Country:US
Practice Address - Phone:304-472-4427
Practice Address - Fax:304-472-4474
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV099332084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0046903000Medicaid
WVWI0672731Medicare ID - Type Unspecified
WVE76008Medicare UPIN