Individual
JACQUELINE A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
5170 US RT 60 EAST, HUNTINGTON, WV 25705
(304) 697-6000
(304) 399-2280
Mailing address
5170 US RT 60 EAST, HUNTINGTON, WV 25705
(304) 697-6000
(304) 399-2280
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
34192
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2233158
—
OH
01
—
500018128
RAILROAD
—
05
—
7102107000
—
WV
Enumeration date
06/09/2006
Last updated
10/25/2021
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