Healthcare Provider Details

I. General information

NPI: 1972018828
Provider Name (Legal Business Name): MYRTLE DENISE JARRELL M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 5TH AVE STE 250
HUNTINGTON WV
25701-2238
US

IV. Provider business mailing address

1000 5TH AVE STE 250
HUNTINGTON WV
25701-2238
US

V. Phone/Fax

Practice location:
  • Phone: 304-733-0036
  • Fax: 304-736-4835
Mailing address:
  • Phone: 304-733-0036
  • Fax: 304-736-4835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: