Individual
FELICIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
69 AVENUE B, MADISON, WV 25130-1162
(304) 369-8245
Mailing address
501 22ND ST, DUNBAR, WV 25064-1711
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
58773
WV
Other
Enumeration date
01/18/2013
Last updated
01/18/2013
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