Healthcare Provider Details

I. General information

NPI: 1780123562
Provider Name (Legal Business Name): CAROL LYNNE GRIFFITH RN, AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 DARST RD
DAYTON OH
45440-3407
US

IV. Provider business mailing address

61 DARST RD
DAYTON OH
45440-3407
US

V. Phone/Fax

Practice location:
  • Phone: 937-424-3589
  • Fax:
Mailing address:
  • Phone: 937-424-3589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.023032
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.023032
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: