Provider Demographics
NPI:1851918494
Name:TAYLOR, JENNIFER NICOLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:SPANISHBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25922-0182
Mailing Address - Country:US
Mailing Address - Phone:304-920-0024
Mailing Address - Fax:
Practice Address - Street 1:435 MEATSHOP ROAD
Practice Address - Street 2:
Practice Address - City:SPANISHBURG
Practice Address - State:WV
Practice Address - Zip Code:25922
Practice Address - Country:US
Practice Address - Phone:304-920-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV106871363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily