Healthcare Provider Details

I. General information

NPI: 1811801731
Provider Name (Legal Business Name): TIFFANI JOHNSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 LIBBY ANN DR
BUNKER HILL WV
25413-3365
US

IV. Provider business mailing address

256 LIBBY ANN DR
BUNKER HILL WV
25413-3365
US

V. Phone/Fax

Practice location:
  • Phone: 304-676-3316
  • Fax:
Mailing address:
  • Phone: 304-676-3316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: