Healthcare Provider Details

I. General information

NPI: 1790384477
Provider Name (Legal Business Name): JAMIE LYNN PEDEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 WASHINGTON ST W STE 200
CHARLESTON WV
25302-2348
US

IV. Provider business mailing address

3031 CRESTWOOD RD
CHARLESTON WV
25302-1651
US

V. Phone/Fax

Practice location:
  • Phone: 304-314-4052
  • Fax:
Mailing address:
  • Phone: 304-389-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: JAMIE PEDEN
Title or Position: OWNER
Credential:
Phone: 304-389-1194