Individual
JENNIFER L LEAVITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2900 EMERSON AVE, PARKERSBURG, WV 26104-2519
(304) 485-0272
(304) 485-0265
Mailing address
936 MARKET ST, PARKERSBURG, WV 26101-4737
(304) 485-0272
(304) 485-0265
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1709
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0590002000
—
WV
01
—
2125613
OHIO MEDICAID
WV
Enumeration date
05/24/2005
Last updated
09/08/2022
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