JACKSON HEALTHCARE CLINIC LLC NPI 1639778731

NPI Information

NPI: 1639778731
Provider Name: JACKSON HEALTHCARE CLINIC LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
2107 PIKE ST STE 3
PARKERSBURG, WV
ZIP 26101
Phone: (681) 229-0984
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JACKSON HEALTHCARE CLINIC LLC is a family nurse practitioner in Parkersburg, WV. JACKSON HEALTHCARE CLINIC LLC NPI is 1639778731. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2107 PIKE ST STE 3
PARKERSBURG, WV
ZIP 26101-973
Phone: (681) 229-0984
Fax: (681) 229-0985

The provider's authorized official is Alisha Jackson .
The authorized official title is Owner and has the following contact phone number (304) 210-0061.

The enumeration date for this NPI number is 10/20/2020 and was last updated on 10/21/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1215491006	OTHER		NPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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