Organization
JACKSON HEALTHCARE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISHA JACKSON APRN (OWNER)
(304) 210-0061
Entity
Organization
Contact information
Practice address
2107 PIKE ST STE 3, PARKERSBURG, WV 26101-6973
(681) 229-0984
(681) 229-0985
Mailing address
2107 PIKE ST STE 3, PARKERSBURG, WV 26101-6973
(681) 229-0984
(681) 229-0985
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215491006
NPI
—
Enumeration date
10/20/2020
Last updated
10/21/2020
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