Individual
JARED T RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-5432
Mailing address
8 NANCY LN, BARBOURSVILLE, WV 25504-1164
(304) 991-7711
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
123379
WV
Other
Enumeration date
03/06/2025
Last updated
06/27/2025
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