Provider Demographics
NPI:1265029318
Name:HADDIX, JENNY LYNN
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:HADDIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:LYNN
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:526 DARK HORSE DR
Mailing Address - Street 2:
Mailing Address - City:VOLGA
Mailing Address - State:WV
Mailing Address - Zip Code:26238-7500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:526 DARK HORSE DR
Practice Address - Street 2:
Practice Address - City:VOLGA
Practice Address - State:WV
Practice Address - Zip Code:26238-7500
Practice Address - Country:US
Practice Address - Phone:304-457-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant