MEDICARE: JAXON NUZUM

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	390200000X	Student in an Organized Health Care Education/Training Program		WV

General Provider Information

NPI Number	:	1942139563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAXON NUZUM

Provider Business Mailing Address
First Line	:	1434 CAROLYN RD
Second Line	:
City	:	FAIRMONT
State	:	WV
Zip	:	26554-5007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1434 CAROLYN RD
Second Line	:
City	:	FAIRMONT
State	:	WV
Zip	:	26554-5007
Country	:	US
Telephone Number	:	304-777-6800
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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Directions to “ JAXON NUZUM ” Practice Location

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