JACQUELINE LEE LICKLITER D.O.
NPI 1053671669
Pediatrics in Beckley, WV

Q: What is Jacqueline Lickliter's NPI number?

The NPI number for Jacqueline Lickliter is 1053671669. It was assigned to this individual provider in the NPPES registry on May 17, 2012.

Q: What is Jacqueline Lickliter's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Active since May 17, 2012PECOS Enrolled

230 GEORGE ST STE 2, BECKLEY, WV 25801(304) 255-2878 Get Directions Write a Review

NPPES record last updated: March 30, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 30, 2026, Jan 27, 2026, Mar 17, 2021 (3 updates tracked since 2021).

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About Jacqueline Lee Lickliter D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACQUELINE LEE LICKLITER D.O. (NPI 1053671669) is an individual pediatrics provider in Beckley, West Virginia, licensed in West Virginia (2950) and active in the NPI registry since May 2012. She is enrolled in Medicare PECOS, maintains a secondary practice location in Boardman, and is a graduate of West Virginia School Of Osteopathic Medicine (2008).

NPPES Registry Identity

NPI1053671669

Entity TypeIndividualFemale

Primary Taxonomy208000000X

Provider Legal NameJACQUELINE LEE LICKLITERCredential: D.O.

Location Address230 GEORGE ST STE 2Beckley, WV 25801-2620

Mailing Address230 George St Ste 2Beckley, WV 25801-2620 · (304) 255-2878

Phone(304) 255-2878

Sole ProprietorNo

Medical School CMSWest Virginia School Of Osteopathic MedicineGraduated 2008

Enumeration DateMay 17, 2012

Last NPPES UpdateMarch 30, 20263 updates tracked since enumeration

NPPES CertifiedMarch 30, 2026

✔ NPI 1053671669 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

Licenses✔ Licensed in WV · 2950✔ Licensed in OH · 34.012256

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

230 GEORGE ST STE 2, Beckley, WV 25801

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Secondary Practice Location 1

Location 16505 Market St Ste 2100Boardman, OH 44512-3457 · Phone (330) 746-8040 · Fax (330) 746-8025

Other Identifiers 1

Medicaid1053671669WV

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include MedMutual.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacqueline Lee Lickliter D.o. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID8426537150

PECOS Enrollment IDI20260212000187

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 25801 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$83.49 typical visit price

range $53.20 – $164.59

Typical copayment $20.87 (range $13.30 – $41.14)

Most-billed visit code 99203

Established Patient

$94.81 typical visit price

range $16.47 – $133.29

Typical copayment $23.70 (range $4.11 – $33.32)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JENNIFER DAWN BRADFORD APRN-CNP

Nurse Practitioner (Primary Care)