Provider Demographics
NPI:1801634084
Name:HUTTON, JESSICA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HUTTON
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 1:1111 VAN VOORHIS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2737
Mailing Address - Country:US
Mailing Address - Phone:304-598-8900
Mailing Address - Fax:
Practice Address - Street 1:1513 HARRISON AVE STE A12
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3356
Practice Address - Country:US
Practice Address - Phone:304-553-7063
Practice Address - Fax:304-591-1038
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV171M00000X
WV37475164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No164W00000XNursing Service ProvidersLicensed Practical Nurse