Individual provider · Type 1 NPI
Angel Jackson
Primary Care Nurse Practitioner · Charleston, WV
NPI number
1407560402
Active
Practice location
400 S Ruffner Rd Ste 11
Charleston, WV 25314-1542
Mailing address
2866 Mudfork Road
Verdunville, WV 25649
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Registered Nurse | 163W00000X | 91990 (WV) |
| Primary Care Nurse Practitioner Primary | 363LP2300X | 123472 (WV) |
Primary Care Nurse Practitioner: Definition to come...
Other primary care nurse practitioner providers in Charleston
About NPI 1407560402
Angel Jackson's National Provider Identifier is 1407560402, issued on Jan 13, 2023. The primary taxonomy on file is Primary Care Nurse Practitioner (363LP2300X), and the practice location is in Charleston, WV. The record was last updated on Jul 29, 2026.