Provider Demographics
NPI:1679182950
Name:JARRELL, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JARRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFITHSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25521-9786
Mailing Address - Country:US
Mailing Address - Phone:304-744-1636
Mailing Address - Fax:
Practice Address - Street 1:607 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:GRIFFITHSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25521-9786
Practice Address - Country:US
Practice Address - Phone:304-744-1636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant