Individual
SALLY JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-4168
Mailing address
212 GILCHRIST AVE, TORNADO, WV 25202-9632
(304) 419-6069
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
91602
WV
Other
Enumeration date
12/16/2025
Last updated
12/16/2025
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