Provider Demographics
NPI:1861686289
Name:WARD, JENINE LYNN (APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:JENINE
Middle Name:LYNN
Last Name:WARD
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 RURAL ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3503
Mailing Address - Country:US
Mailing Address - Phone:304-253-2628
Mailing Address - Fax:304-252-1720
Practice Address - Street 1:200 RALEIGH AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-0002
Practice Address - Country:US
Practice Address - Phone:304-252-8541
Practice Address - Fax:304-253-2507
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV57335363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001982076OtherBCBS
WV3810009846Medicaid
WVNP24911Medicare PIN