Jacqlyn Patrice Robertson
Individual provider Active NPI Personal Care Attendant · Wallace, WV
NPI 1447058086 · NPPES record last updated Mar 7, 2025
Key facts
- NPI
- 1447058086
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Personal Care Attendant 3747P1801X
- Practice address
- 2525 Big Elk Rd
Wallace, WV 26448-8529 - Phone
- (304) 844-1001
- NPI assigned
- Mar 7, 2025
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Personal Care Attendant | 3747P1801X | Yes |
Addresses
Primary practice location
2525 Big Elk Rd
Wallace, WV 26448-8529
Mailing address
2525 Big Elk Rd
Wallace, WV 26448-8529
Phone (304) 844-1001
Other providers in Wallace, WV
All providers in Wallace, WV · Personal Care Attendant in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.