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Contact Information

JACKIE NICKERSON
59071 CROZIER RD
JACKSONBURG, WV43933
 Phone: 740-579-2697
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Personal Care Attendant

3747P1801X
Indicates primary specialty

NPI Profile & details for JACKIE NICKERSON · (Female)

NPI # 1184510117
Status Active
Credentials
Entity Individual
Enumeration date 06/16/2025
Last updated 06/16/2025 - About 12 months ago
Sole proprietor 1 No
Identifiers
  • WV Medicaid 125553494
  • WV Medicaid 1356607394
  • WV Medicaid 1821206228
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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