Provider Demographics
NPI:1710649009
Name:TAYLOR, JEROME ANDRE
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:ANDRE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3041
Mailing Address - Country:US
Mailing Address - Phone:304-435-9881
Mailing Address - Fax:
Practice Address - Street 1:383 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3041
Practice Address - Country:US
Practice Address - Phone:304-435-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant