Healthcare Provider Details

I. General information

NPI: 1235724410
Provider Name (Legal Business Name): RUTH TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 WHITE HOLLOW RD
MONTCALM WV
24737-1106
US

IV. Provider business mailing address

PO BOX 141
MONTCALM WV
24737-0141
US

V. Phone/Fax

Practice location:
  • Phone: 304-320-5029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: