MEDICARE: TIFFANY DEARING

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	363LF0000X	Family Nurse Practitioner	118654	WV

General Provider Information

NPI Number	:	1215791074
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY DEARING

Provider Business Mailing Address
First Line	:	175 KINGS CT
Second Line	:
City	:	HARRISVILLE
State	:	WV
Zip	:	26362-1184
Country	:	US
Telephone Number	:	304-941-5118
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 SOUTHLAND DR STE 2400
Second Line	:
City	:	FAIRMONT
State	:	WV
Zip	:	26554-2247
Country	:	US
Telephone Number	:	304-376-3650
Fax Number	:

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

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/12/2024

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Directions to “ TIFFANY DEARING ” Practice Location

Language	Start Address	Practice Location

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