MEDICARE: MRS. FAITH ANNETTE GRIFFITH FNP-BC

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	163WR0006X	Registered Nurse First Assistant	35364	WV
2	363LF0000X	Family Nurse Practitioner	APRN.CNP.020785	OH
3	363LF0000X	Family Nurse Practitioner	APRN35364	WV

General Provider Information

NPI Number	:	1366581647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FAITH ANNETTE GRIFFITH FNP-BC

Provider Business Mailing Address
First Line	:	3200 MACCORKLE AVE SE FL 4
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1297
Country	:	US
Telephone Number	:	304-388-8199
Fax Number	:	304-388-8195

Provider Business Practice Location Address
First Line	:	3200 MACCORKLE AVE SE FL 4
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1297
Country	:	US
Telephone Number	:	304-388-8199
Fax Number	:	304-388-8195

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	03/07/2022

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