Provider Demographics
NPI:1194717603
Name:FORD, JOY P (PA-C)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:P
Last Name:FORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:P
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5870 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-9105
Mailing Address - Country:US
Mailing Address - Phone:304-872-3709
Mailing Address - Fax:
Practice Address - Street 1:5870 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9105
Practice Address - Country:US
Practice Address - Phone:304-872-3709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1020363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810005937Medicaid
WV2029916Medicare PIN
WV2029917Medicare PIN
WV3810005937Medicaid