Healthcare Provider Details

I. General information

NPI: 1710940143
Provider Name (Legal Business Name): JENNIFER LYNN WESTFALL C-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 CHESTERFIELD AVE
CHARLESTON WV
25304-1125
US

IV. Provider business mailing address

2930 CHESTERFIELD AVE
CHARLESTON WV
25304-1125
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-9923
  • Fax: 304-343-9925
Mailing address:
  • Phone: 304-343-9923
  • Fax: 304-343-9925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN52686-FNP-BC
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: