MEDICARE: MRS. TIFFANY NICHOLE NORRIS

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	174400000X	Specialist	01947	KY

General Provider Information

NPI Number	:	1518087725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANY NICHOLE NORRIS

Provider Business Mailing Address
First Line	:	RR 2 BOX 899
Second Line	:
City	:	ALBANY
State	:	KY
Zip	:	42602-9568
Country	:	US
Telephone Number	:	606-387-3420
Fax Number	:	606-387-3420

Provider Business Practice Location Address
First Line	:	RR 2 BOX 899
Second Line	:
City	:	ALBANY
State	:	KY
Zip	:	42602-9568
Country	:	US
Telephone Number	:	606-387-3420
Fax Number	:	606-387-3420

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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