Healthcare Provider Details

I. General information

NPI: 1578428694
Provider Name (Legal Business Name): TIFFANY ADAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 1ST AVE
HUNTINGTON WV
25702-1241
US

IV. Provider business mailing address

119 ADA DELL AVE
HURRICANE WV
25526-1701
US

V. Phone/Fax

Practice location:
  • Phone: 304-526-1234
  • Fax:
Mailing address:
  • Phone: 304-590-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number119294
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: