Healthcare Provider Details

I. General information

NPI: 1588059687
Provider Name (Legal Business Name): CHARLEA TAYLOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7412 PARKERSBURG RD
SANDYVILLE WV
25275-7508
US

IV. Provider business mailing address

2507 9TH AVE
PARKERSBURG WV
26101-5855
US

V. Phone/Fax

Practice location:
  • Phone: 304-273-3511
  • Fax:
Mailing address:
  • Phone: 304-485-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number82460
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: