Individual
JENNIFER L PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
122 12TH ST, PRINCETON, WV 24740
(304) 487-7000
Mailing address
PO BOX 634715, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
878
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00343573
MEDICARE RAILROAD
WV
Enumeration date
06/09/2006
Last updated
11/09/2007
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