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Individual

CORY DAVID JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
FNP-BC

Contact information

Practice address
1340 HAL GREER BLVD, HUNTINGTON, WV 25701-3804
(304) 399-6727
(304) 399-6726
Mailing address
5507 SHAWNEE DR, HUNTINGTON, WV 25705-3305
(304) 690-0320

Taxonomy

Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
96293
WV
363LF0000X
Family Nurse Practitioner
Primary
96293
WV

Other

Enumeration date
06/10/2020
Last updated
05/21/2024
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