Jackson, Jacqueline A
Jackson, Jacqueline A is an individual health care provider with primary practice located at 5170 Us Rt 60 East , Huntington WV 25705. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Jackson, Jacqueline A can be contacted via phone (304) 697-6000.Contact Information
Primary practice address
5170 Us Rt 60 East
Huntington WV 25705
Phone: (304) 697-6000
Fax: (304) 399-2280
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 34192 | West Virginia |
Profile Details
| NPI number | 1578504569 |
|---|---|
| LBN Legal business name | Jackson, Jacqueline A |
| Credentials | Certified Family Nurse Practitioner (CFNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 9th, 2006 |
| Last updated | Oct 25th, 2021 - about 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578504569 | NPPES |
| Ohio | MEDICAID | 2233158 | |
| Ohio | MEDICAID | 7102107000 | |
| Ohio | Other | 500018128 |
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