Individual
KELLY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
65 WELL RD, CRAIGSVILLE, WV 26205
(304) 651-1728
Mailing address
PO BOX 1152, CRAIGSVILLE, WV 26205-1152
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
03/24/2021
Last updated
03/24/2021
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