Healthcare Provider Details

I. General information

NPI: 1295799385
Provider Name (Legal Business Name): MICHELLE L. RIFFE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE L. RIFFE DAVIS PA-C

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 11/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 6TH AVE SUITE 100
MONTGOMERY WV
25136-2116
US

IV. Provider business mailing address

401 6TH AVE SUITE 100
MONTGOMERY WV
25136-2116
US

V. Phone/Fax

Practice location:
  • Phone: 304-442-8516
  • Fax: 304-442-0212
Mailing address:
  • Phone: 304-442-8516
  • Fax: 304-442-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number689
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: