IndividualActive
Angel Jackson
NPI 1407560402 · Registered Nurse · Charleston, WV
Provider details
- NPI number
- 1407560402
- Entity type
- Individual
- Primary specialty
- Registered NurseNursing Service Providers
- Sex
- Female
- Sole proprietor
- No
- License
- 91990 (WV)
Specialties & taxonomies
Nursing Service Providers
Physician Assistants & Advanced Practice Nursing Providers
Practice location
400 S Ruffner Rd Ste 11
Charleston, WV 25314-1542
Phone: (304) 720-9595
Approximate (ZIP-level) locationGet directions
Mailing address
2866 Mudfork Road
Verdunville, WV 25649
Registry dates
- Enumerated
- 2023-01-13
- Last updated
- 2026-03-04
- Certified
- 2026-03-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.