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NPI Code Detail

MEDICARE: TIFFANY CHRISTIAN BA

MEDICARE: TIFFANY CHRISTIAN BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1881277812
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY CHRISTIAN BA
Provider Business Mailing Address
First Line : 1596 WASHINGTON BLVD
Second Line :
City : HUNTINGTON
State : WV
Zip : 25701-4035
Country : US
Telephone Number : 681-378-3881
Fax Number :
Provider Business Practice Location Address
First Line : 1596 WASHINGTON BLVD
Second Line :
City : HUNTINGTON
State : WV
Zip : 25701-4035
Country : US
Telephone Number : 681-378-3881
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2021
Last Update Date : 04/28/2021

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Directions to “ TIFFANY CHRISTIAN BA” Practice Location

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