Healthcare Provider Details

I. General information

NPI: 1174255442
Provider Name (Legal Business Name): TIFFANY DANIELLE YEAGER PRSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2444 COLLIS AVE
HUNTINGTON WV
25703-1235
US

IV. Provider business mailing address

1649 KING ST
SOUTH CHARLESTON WV
25303-1807
US

V. Phone/Fax

Practice location:
  • Phone: 681-888-5564
  • Fax:
Mailing address:
  • Phone: 304-691-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: