Provider Demographics
NPI:1992106132
Name:CUNNINGHAM, JACQUELYN MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:MARIE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JACQUELYN
Other - Middle Name:MARIE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 923
Mailing Address - Street 2:ONE MEDICAL CENTER DR.
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-293-8266
Mailing Address - Fax:
Practice Address - Street 1:ONE MEDICAL CENTER DR.
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-293-8266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1119183OtherNCCPA CERTIFICATION NUMBER