Provider Demographics
NPI:1215967443
Name:TALKINGTON, JENNIFER ANN (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:TALKINGTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 PHEASANT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-7984
Mailing Address - Country:US
Mailing Address - Phone:304-709-3506
Mailing Address - Fax:304-225-0927
Practice Address - Street 1:1255 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2738
Practice Address - Country:US
Practice Address - Phone:304-598-3301
Practice Address - Fax:304-225-0927
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46020367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0069663000Medicaid
WV0069663000Medicaid
WV8221434Medicare PIN
WV0069663000Medicaid
WV001706470OtherMSBCBS GROUP
WV8221434Medicare PIN
MD406129200Medicaid
WV270052997004OtherTRICARE
WVP00137194OtherRR MEDICARE
WV0207026000Medicaid
WV27005299701OtherBRICKSTREET