Basic Information
| Provider Information | |||||||||
| NPI: | 1215284492 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RANSON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 612 5TH ST | ||||||||
| Address2: | |||||||||
| City: | SAINT ALBANS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 251772858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047290015 | ||||||||
| FaxNumber: | 3047290016 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 KANAWHA TER | ||||||||
| Address2: | |||||||||
| City: | SAINT ALBANS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 251772750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042011130 | ||||||||
| FaxNumber: | 3042011134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2012 | ||||||||
| LastUpdateDate: | 10/16/2018 | ||||||||
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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 | 363LF0000X | APRN56380 | WV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 2012008450 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1215284492 | 05 | WV | MEDICAID |