Healthcare Provider Details

I. General information

NPI: 1346947397
Provider Name (Legal Business Name): JENNIFER DAGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W CORK ST UNIT 405
WINCHESTER VA
22601-3876
US

IV. Provider business mailing address

107 FOXHALL RD
CHARLES TOWN WV
25414-2502
US

V. Phone/Fax

Practice location:
  • Phone: 540-313-9200
  • Fax: 540-686-7287
Mailing address:
  • Phone: 304-707-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number102035
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number117157
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number0020191270
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: