Individual
JAMIE LYNN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1236 5TH AVE, HUNTINGTON, WV 25701-2207
(681) 204-5400
Mailing address
1236 5TH AVE, HUNTINGTON, WV 25701-2207
(304) 563-5776
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
000000
WV
Other
Enumeration date
12/14/2022
Last updated
12/14/2022
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