Healthcare Provider Details

I. General information

NPI: 1104774215
Provider Name (Legal Business Name): JENNAH ASHTAN RAYANN WORKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 PAINTER BRANCH
CYCLONE WV
24827
US

IV. Provider business mailing address

PO BOX 363
CYCLONE WV
24827-0363
US

V. Phone/Fax

Practice location:
  • Phone: 304-922-6374
  • Fax:
Mailing address:
  • Phone: 304-922-6374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: