| Doctor Name: | MRS. JACLYN NICOLE BLAND |
| NPI Number: | 1831308527 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | P.A-C |
| License Number: | 01038 |
| Business Practice Address: | 200 Route 98 W St 310 Nutter Fort, WV - 263014385 |
| Business Phone Number: | 3026240980 |
| Business Fax Number: | 3046240095 |
| Mailing Address: | 200 Route 98 W St, 310 NUTTER FORT |
| State: | WV |
| Postal Code: | 263014385 |
| Phone Number: | 3026240980 |
| Fax Number: | 3046240095 |
| NPI Enumeration Date: | 05/21/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 01038 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |