Individual
JENNIFER MCCLUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
900 VIRGINIA ST E, CHARLESTON, WV 25301-2835
(681) 313-4759
Mailing address
900 VIRGINIA ST E, CHARLESTON, WV 25301-2835
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
39792
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00
—
WV
05
—
05
—
WV
Enumeration date
10/24/2022
Last updated
10/24/2022
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