Healthcare Provider Details

I. General information

NPI: 1518136704
Provider Name (Legal Business Name): MRS. TIFFANY SUE FARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. TIFFANY FARRELL

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 N KENNEBEC AVE
MCCONNELSVILLE OH
43756-1016
US

IV. Provider business mailing address

1165 N KENNEBEC AVE
MCCONNELSVILLE OH
43756-1016
US

V. Phone/Fax

Practice location:
  • Phone: 740-507-2598
  • Fax:
Mailing address:
  • Phone: 740-507-2598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberRU599210
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: