Individual
MR. JASON R SOUTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2 STONECREST DR, HUNTINGTON, WV 25701-9391
(304) 525-2273
(304) 525-2165
Mailing address
2 STONECREST DR, HUNTINGTON, WV 25701-9391
(304) 525-2273
(304) 525-2165
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
01257
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0080128
—
OH
05
—
1316117930
—
WV
05
—
7100109950
—
KY
01
—
P0071530
RR
WV
Enumeration date
03/11/2008
Last updated
02/16/2026
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