Healthcare Provider Details

I. General information

NPI: 1770492159
Provider Name (Legal Business Name): JACQUELINE BROWN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 SAGE LN
RIPLEY WV
25271-6099
US

IV. Provider business mailing address

274 SAGE LN
RIPLEY WV
25271-6099
US

V. Phone/Fax

Practice location:
  • Phone: 304-542-5111
  • Fax:
Mailing address:
  • Phone: 304-542-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: