Healthcare Provider Details

I. General information

NPI: 1649673823
Provider Name (Legal Business Name): JEFFREY JUDE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MCCOY RD
HUNTINGTON WV
25701-4937
US

IV. Provider business mailing address

2001 MCCOY RD
HUNTINGTON WV
25701-4937
US

V. Phone/Fax

Practice location:
  • Phone: 304-529-6205
  • Fax: 304-529-6209
Mailing address:
  • Phone: 304-529-6205
  • Fax: 304-529-6209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number59917
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: