Individual
JESSICA SIOBHAN DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2604 GRANGE HALL ROAD, EGLON, WV 26716-0008
(304) 735-3155
(304) 735-3409
Mailing address
2604 GRANGE HALL ROAD, EGLON, WV 26716
(304) 735-3155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810026498
—
WV
Enumeration date
08/15/2013
Last updated
05/03/2016
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