Individual
JACKIE D SHORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1650 MAIN STREET, PINEVILLE, WV 24874
(304) 732-6735
(304) 732-9218
Mailing address
PO BOX 1650, FAMILY HEALTHCARE ASSOC INC, PINEVILLE, WV 24874
(304) 732-6735
(304) 732-9218
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
299
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810000497
—
WV
Enumeration date
10/23/2006
Last updated
02/12/2010
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