Provider Demographics
NPI:1528038668
Name:HADLEY, JENIFER (DO)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:HADLEY
Suffix:
Gender:F
Credentials:DO
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 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3100 MACCORKLE AVE SE STE 700
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1230
Practice Address - Country:US
Practice Address - Phone:304-351-1500
Practice Address - Fax:304-351-1510
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001709560OtherMT. STATE
WV00232938OtherRR MEDICARE
WV3810000321Medicaid
WVI10833Medicare UPIN
WV2025463Medicare PIN
WV2025461Medicare PIN