Healthcare Provider Details

I. General information

NPI: 1699685024
Provider Name (Legal Business Name): JADA LOVE KECKLEY CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17978 STATE ROAD 55
BAKER WV
26801-8626
US

IV. Provider business mailing address

266 BEULAH WAY
AUGUSTA WV
26704-1212
US

V. Phone/Fax

Practice location:
  • Phone: 304-897-8220
  • Fax: 304-897-8210
Mailing address:
  • Phone: 304-897-8220
  • Fax: 304-897-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPT0011752
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: