Individual
JESSICA ANNE MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
40 MEDICAL PARK ROAD SUITE 508, WHEELING, WV 26003-6861
(304) 243-8916
Mailing address
40 MEDICAL PARK ROAD SUITE 508, WHEELING, WV 26003
(304) 243-8916
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
2489
WV
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/20/2019
Last updated
10/08/2024
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