Individual
ANGEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 S RUFFNER RD STE 11, CHARLESTON, WV 25314-1542
(304) 720-9595
Mailing address
2866 MUDFORK ROAD, VERDUNVILLE, WV 25649
(304) 784-0989
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
91990
WV
363LP2300X
Primary Care Nurse Practitioner
123472
WV
Other
Enumeration date
01/13/2023
Last updated
03/04/2026
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