Provider Demographics
NPI:1316593270
Name:TOATH-CALLAHAN, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TOATH-CALLAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 RIVIERA RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT NEBO
Mailing Address - State:WV
Mailing Address - Zip Code:26679-8264
Mailing Address - Country:US
Mailing Address - Phone:304-872-4222
Mailing Address - Fax:304-369-2920
Practice Address - Street 1:438 RIVIERA RD
Practice Address - Street 2:
Practice Address - City:MOUNT NEBO
Practice Address - State:WV
Practice Address - Zip Code:26679-8264
Practice Address - Country:US
Practice Address - Phone:304-872-4222
Practice Address - Fax:304-369-2920
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV102548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty