=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205550746
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIARA LYN FERRELL APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2022
-----------------------------------------------------
Last Update Date | 11/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 174 MENTAL HEALTH RD
-----------------------------------------------------
City | LOGAN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-792-7130
-----------------------------------------------------
Fax | 304-792-7146
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 E 2ND AVE
-----------------------------------------------------
City | WILLIAMSON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25661-3602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-784-7165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 3018378
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 114484
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 114484
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------