Provider Demographics
NPI:1487858775
Name:CROSS, JENNY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:LYNN
Last Name:CROSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:911 GORMAN AVENUE
Mailing Address - Street 2:DAVIS MEDICAL CENTER; DBA TYGART VALLEY MEDICAL SPECIAL
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241
Mailing Address - Country:US
Mailing Address - Phone:304-637-6302
Mailing Address - Fax:304-637-6307
Practice Address - Street 1:911 GORMAN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3082
Practice Address - Country:US
Practice Address - Phone:304-637-6302
Practice Address - Fax:304-637-6307
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV21597207Y00000X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009381Medicaid
WV21597OtherWV MEDICAL LICENSE NUMER
WVP00423429OtherRAILROAD MEDICARE
WV001975500OtherMOUNTAIN STATE BCBS
WVWV21597OtherHEALTH PLAN
WVCR4214751Medicare PIN