Provider Demographics
NPI:1043916554
Name:TAYLOR, REVA D
Entity type:Individual
Prefix:
First Name:REVA
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:WV
Mailing Address - Zip Code:24938-0119
Mailing Address - Country:US
Mailing Address - Phone:304-646-7715
Mailing Address - Fax:
Practice Address - Street 1:21729 SENECA TRAIL NORTH
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:WV
Practice Address - Zip Code:24938
Practice Address - Country:US
Practice Address - Phone:304-646-7715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant