Provider Demographics
NPI:1679242846
Name:WHITE, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:
Mailing Address - City:MOUNT NEBO
Mailing Address - State:WV
Mailing Address - Zip Code:26679-0569
Mailing Address - Country:US
Mailing Address - Phone:304-883-2334
Mailing Address - Fax:
Practice Address - Street 1:785 SUMMERSVILLE LAKE RD
Practice Address - Street 2:
Practice Address - City:MOUNT NEBO
Practice Address - State:WV
Practice Address - Zip Code:26679-9203
Practice Address - Country:US
Practice Address - Phone:304-883-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant