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:
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Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578504569 NPPES
Ohio MEDICAID 2233158
Ohio MEDICAID 7102107000
Ohio Other 500018128

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