Male or Other

Jacob Edmond PR

Peer Specialist in Huntington, WV(View on Map)

Full Name

Jacob Edmond PR

NPI Number

1265177703

NPI Type

Individual Provider

Gender

Male

Enumeration Date

04/29/2022

Specialties

(Taxonomies)

Code

175T00000X

Primary Taxonomy

Yes

Licenses

State

West Virginia

License Number

22-929

Contact
Information

Purpose

Mailing
Location

Address

137 8TH AVE W
137 8TH AVE W

City

Huntington
Huntington

State

WV
WV

Postal Code

25701-2510
25701-2510

Country

US
US

Telephone Number

(681) 888-5291
(681) 888-5291

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 12/09/2022

Provider Address

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