Healthcare Provider Details

I. General information

NPI: 1104464999
Provider Name (Legal Business Name): BRITTANY D GRIFFITH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2019
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PENNSYLVANIA AVE STE 402
CHARLESTON WV
25302-3390
US

IV. Provider business mailing address

830 PENNSYLVANIA AVE STE 402
CHARLESTON WV
25302-3390
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-4177
  • Fax:
Mailing address:
  • Phone: 304-343-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number104901
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number104901
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: