Healthcare Provider Details

I. General information

NPI: 1548921224
Provider Name (Legal Business Name): TIFFANY S HURTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 1/2 BURGESS ST
BECKLEY WV
25801-5901
US

IV. Provider business mailing address

PO BOX 131
MAC ARTHUR WV
25873-0131
US

V. Phone/Fax

Practice location:
  • Phone: 304-712-1960
  • Fax:
Mailing address:
  • Phone: 304-712-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: