Healthcare Provider Details

I. General information

NPI: 1083497929
Provider Name (Legal Business Name): TIFFANY HURLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 W 3RD AVE
WILLIAMSON WV
25661-3007
US

IV. Provider business mailing address

PO BOX 1406
WILLIAMSON WV
25661-1406
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-1701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: