Healthcare Provider Details

I. General information

NPI: 1871852285
Provider Name (Legal Business Name): JAMIE L FYFFE C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4437 STATE ROUTE 159 #125
CHILLICOTHEE OH
45601-7065
US

IV. Provider business mailing address

955 CLIFFSIDE DR
CHILLICOTHEE OH
45601-2918
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4570
  • Fax:
Mailing address:
  • Phone: 740-703-5708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNEW
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: