Provider Demographics
NPI:1235325051
Name:GOARD, JODY RUTH (NP)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:RUTH
Last Name:GOARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:RUTH
Other - Last Name:STAGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP- BC, AGACNP-BC
Mailing Address - Street 1:PO BOX 7000
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-7000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 MORRIS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1326
Practice Address - Country:US
Practice Address - Phone:304-388-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-16
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV62704363LA2100X, 363LF0000X
VA0024183184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care