Individual
MS. TARA LEIGH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
123 JAMES RIVER & KANAWHA TURNPIKE, ANSTED, WV 25812
(304) 228-6809
(304) 658-4690
Mailing address
123 JAMES RIVER & KANAWHA TURNPIKE, ANSTED, WV 25812
(304) 228-6809
(304) 658-4690
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
67047
WV
Other
Enumeration date
04/04/2013
Last updated
04/04/2013
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