Basic Information
| Provider Information | |||||||||
| NPI: | 1053599118 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACKSON | ||||||||
| FirstName: | DAUN | ||||||||
| MiddleName: | LEAH | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | RR 1 BOX 148F | ||||||||
| Address2: | |||||||||
| City: | OAK HILL | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044650415 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 HEARTLAND DRIVE | ||||||||
| Address2: | HEARTLAND OF BECKLEY | ||||||||
| City: | BECKLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042561650 | ||||||||
| FaxNumber: | 3042561657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2008 | ||||||||
| LastUpdateDate: | 01/31/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 36724 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.