MEDICARE: JENNIFER RENEE THAXTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1750271391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RENEE THAXTON

Provider Business Mailing Address
First Line	:	32 PINE VALLEY DR
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25320-9731
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 PINE VALLEY DR
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25320-9731
Country	:	US
Telephone Number	:	681-280-8194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	07/07/2025

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Directions to “ JENNIFER RENEE THAXTON ” Practice Location

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