Individual
JATEIYA CROSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
175 PHILPOTT LN, BEAVER, WV 25813-9501
(304) 254-9262
Mailing address
175 PHILPOTT LN, BEAVER, WV 25813-9501
(304) 254-9262
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y8Z4D8E7
MA
WV
Enumeration date
03/28/2022
Last updated
03/28/2022
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