Healthcare Provider Details

I. General information

NPI: 1356451702
Provider Name (Legal Business Name): JENNIFER SHREVES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 MIDDLETOWN LOOP
FAIRMONT WV
26554-8701
US

IV. Provider business mailing address

1200 J D ANDERSON DR
MORGANTOWN WV
26505-3494
US

V. Phone/Fax

Practice location:
  • Phone: 304-333-1150
  • Fax: 304-333-1169
Mailing address:
  • Phone: 304-598-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number17953
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: