Healthcare Provider Details

I. General information

NPI: 1669384657
Provider Name (Legal Business Name): JASON MICHAEL JANNEY FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MACCORKLE AVE SE
CHARLESTON WV
25304-1045
US

IV. Provider business mailing address

2300 MACCORKLE AVE SE
CHARLESTON WV
25304-1045
US

V. Phone/Fax

Practice location:
  • Phone: 800-995-4682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number114307
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: