Provider Demographics
NPI:1144300773
Name:YOOST, JENNIE LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:LEE
Last Name:YOOST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 4500
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3656
Mailing Address - Country:US
Mailing Address - Phone:304-691-1400
Mailing Address - Fax:304-691-1453
Practice Address - Street 1:1600 MEDICAL CENTER DR STE 4500
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3655
Practice Address - Country:US
Practice Address - Phone:304-691-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43253207VG0400X
WV25105207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50028892OtherPASSPORT PCP & PAD # FOR FOUNDATION LOCATION
KY50028893OtherPASSPORT SPECIALIST & PASSPORT ADVANTAGE#-FOUNDATION LOCATION
KY7100118390Medicaid
KYK027670OtherMEDICARE PTAN # - KCPAG
KY50028894OtherPASSPORT SPECIALIST & PAD - PSC LOCATION
KY50034507OtherPASSPORT & PP ADVTG - WS
KYP400017669Medicare PIN
KYP400017670Medicare PIN