MEDICARE: DR. TIFFANY MELISSA GADDIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	016616	KY

General Provider Information

NPI Number	:	1194139998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANY MELISSA GADDIS

Provider Business Mailing Address
First Line	:	1589 HIGHWAY 15 S
Second Line	:
City	:	JACKSON
State	:	KY
Zip	:	41339-9634
Country	:	US
Telephone Number	:	606-666-2622
Fax Number	:	606-666-7894

Provider Business Practice Location Address
First Line	:	1589 HIGHWAY 15 S
Second Line	:
City	:	JACKSON
State	:	KY
Zip	:	41339-9634
Country	:	US
Telephone Number	:	606-666-2622
Fax Number	:	606-666-7894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	12/04/2023

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