Individual
JENNA M BAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1320 MAPLEWOOD AVE, RONCEVERTE, WV 24970-8016
(304) 647-6006
Mailing address
501 MORRIS ST, CHARLESTON, WV 25301-1326
(304) 647-6006
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
105700
WV
363LF0000X
Family Nurse Practitioner
4019424
KY
Other
Enumeration date
04/15/2019
Last updated
01/02/2025
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