Nichole Linda Jack
Individual provider Active NPI Personal Care Attendant · Bruceton Mills, WV
NPI 1922699487 · NPPES record last updated Jan 28, 2021
Key facts
- NPI
- 1922699487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Personal Care Attendant 3747P1801X
- Practice address
- 47 Krys View Dr Apt 432
Bruceton Mills, WV 26525-9775 - Phone
- (304) 282-8293
- NPI assigned
- Jan 28, 2021
- 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
47 Krys View Dr Apt 432
Bruceton Mills, WV 26525-9775
Mailing address
47 Krys View Dr Apt 432
Bruceton Mills, WV 26525-9775
Phone (304) 282-8293
Other providers in Bruceton Mills, WV
- Max A Harned
- Heather Marie Hartsell
- John Hayes
- Kendra Hornick
- Ann Hunt
- Tiffany Jaeger
- Courtney Marie Johnson
- Sarah Michelle Jones
- Autumn Keplinger
- Robin Langan
All providers in Bruceton Mills, 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 Jan 28, 2021. 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.