Provider Demographics
NPI:1053599118
Name:JACKSON, DAUN LEAH (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DAUN
Middle Name:LEAH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 148F
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901
Mailing Address - Country:US
Mailing Address - Phone:304-465-0415
Mailing Address - Fax:
Practice Address - Street 1:100 HEARTLAND DRIVE
Practice Address - Street 2:HEARTLAND OF BECKLEY
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-256-1650
Practice Address - Fax:304-256-1657
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV36724363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner