Provider Demographics
NPI:1205883477
Name:WOY GOULD, JESSICA FAE (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:FAE
Last Name:WOY GOULD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:FAE
Other - Last Name:WOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-0944
Mailing Address - Country:US
Mailing Address - Phone:304-788-6462
Mailing Address - Fax:304-788-6555
Practice Address - Street 1:RR 3 BOX 3267
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-9422
Practice Address - Country:US
Practice Address - Phone:304-788-6462
Practice Address - Fax:304-788-6555
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine