Provider Demographics
NPI:1649028390
Name:JARRELL, ANGELA MICHELLE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
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:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:VAN
Mailing Address - State:WV
Mailing Address - Zip Code:25206-0151
Mailing Address - Country:US
Mailing Address - Phone:304-688-3136
Mailing Address - Fax:
Practice Address - Street 1:54 COVE LANE
Practice Address - Street 2:
Practice Address - City:VAN
Practice Address - State:WV
Practice Address - Zip Code:25206
Practice Address - Country:US
Practice Address - Phone:304-688-3136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant