Jaquline Graham
Individual provider Active NPI Community Health Worker · Dixie, WV
NPI 1750144697 · NPPES record last updated Feb 2, 2024
Key facts
- NPI
- 1750144697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community Health Worker 172V00000X
- Practice address
- 63 Polo Street
Dixie, WV 25059 - Phone
- (304) 894-6654
- NPI assigned
- Feb 2, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Yes |
Addresses
Primary practice location
63 Polo Street
Dixie, WV 25059
Mailing address
63 Polo Street
Dixie, WV 25059
Phone (304) 894-6654
Other providers in Dixie, WV
All providers in Dixie, WV · Community Health Worker 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 Feb 2, 2024. 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.