Provider Demographics
NPI:1376972422
Name:JACKSON, STEPHANIE HOPE (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:HOPE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 SKIDMORE LN
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-9271
Mailing Address - Country:US
Mailing Address - Phone:304-765-0351
Mailing Address - Fax:304-765-7019
Practice Address - Street 1:266 SKIDMORE LN
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-9271
Practice Address - Country:US
Practice Address - Phone:304-765-0351
Practice Address - Fax:304-765-7019
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN79343-FNP-BC363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner