Individual
JESSICA PEYTON PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
501 MORRIS ST, CHARLESTON, WV 25301-1326
(304) 388-5432
Mailing address
501 MORRIS ST, CHARLESTON, WV 25301-1326
(304) 388-5432
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
97191
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
116714
WV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2022
Last updated
07/20/2023
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