Provider Demographics
NPI:1740938372
Name:JENNINGS, QUADRA SHANTEL
Entity type:Individual
Prefix:
First Name:QUADRA
Middle Name:SHANTEL
Last Name:JENNINGS
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 1:722 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2613
Mailing Address - Country:US
Mailing Address - Phone:304-544-7111
Mailing Address - Fax:
Practice Address - Street 1:722 5TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2613
Practice Address - Country:US
Practice Address - Phone:304-544-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant