Provider Demographics
NPI:1578231767
Name:TAYLOR, JIMI PAULETTE
Entity Type:Individual
Prefix:
First Name:JIMI
Middle Name:PAULETTE
Last Name:TAYLOR
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 1:9479 VICTORY AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-7973
Mailing Address - Country:US
Mailing Address - Phone:304-672-3834
Mailing Address - Fax:
Practice Address - Street 1:127 GARRETT MILLS LN APT 103
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-9734
Practice Address - Country:US
Practice Address - Phone:304-518-8645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker