Individual
MRS. JENNIFER NICOLE PENNINGTON TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1500 TERRACE STREET, HINTON, WV 25951
(304) 466-2905
(304) 466-2917
Mailing address
1500 TERRACE STREET, PO BOX 940, HINTON, WV 25951
(304) 466-2905
(304) 466-2917
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
01014
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810001365
—
WV
01
—
520795528
AETNA
WV
Enumeration date
10/24/2005
Last updated
07/08/2007
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