Healthcare Provider Details

I. General information

NPI: 1336034487
Provider Name (Legal Business Name): JENNIFER RENAE NESTOR RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W MAIN ST STE 203
KINGWOOD WV
26537-1131
US

IV. Provider business mailing address

106 W MAIN ST STE 203
KINGWOOD WV
26537-1131
US

V. Phone/Fax

Practice location:
  • Phone: 304-329-0096
  • Fax: 304-329-3103
Mailing address:
  • Phone: 304-329-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number52283
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: