Gore, Jacqueline E.

Gore, Jacqueline E. is an individual health care provider with primary practice located at 4605 Maccorkle Ave Sw , South Charleston WV 25309-1311. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Gore, Jacqueline E. can be contacted via phone (304) 766-3600.

Contact Information

Primary practice address
4605 Maccorkle Ave Sw South Charleston WV 25309-1311
Phone: (304) 766-3600
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 044318 West Virginia

Profile Details

NPI number 1689607640
LBN Legal business name Gore, Jacqueline E.
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 9th, 2006
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689607640 NPPES
West Virginia MEDICAID 0068744000

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