Provider Demographics
NPI:1760101471
Name:CLOUD, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:CLOUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 FERRELL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-7496
Mailing Address - Country:US
Mailing Address - Phone:304-982-2117
Mailing Address - Fax:
Practice Address - Street 1:711 FERRELL RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-7496
Practice Address - Country:US
Practice Address - Phone:304-982-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant