Jordan Wallace
Individual provider Active NPI Home Health Aide · Man, WV
NPI 1962391359 · NPPES record last updated Jun 30, 2025
Key facts
- NPI
- 1962391359
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Health Aide 374U00000X
- Practice address
- 503 E McDonald Ave
Man, WV 25635-1014 - Phone
- (304) 687-0172
- NPI assigned
- Jun 30, 2025
- Sex
- Unspecified or another gender identity
- 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 |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | Yes |
Addresses
Primary practice location
503 E McDonald Ave
Man, WV 25635-1014
Mailing address
503 E McDonald Ave
Man, WV 25635-1014
Other providers in Man, WV
- Michelle L. Toler
- Stephanie Toler
- Uphill Physical Therapy and Pelvic Rehab
- Walgreen Co
- Walgreen Co.
- John White III
- Melissa White
All providers in Man, WV · Home Health Aide 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 Jun 30, 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.