Provider Demographics
NPI:1083633937
Name:RIFFE, JENNIFER R (PAC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:R
Last Name:RIFFE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1106
Mailing Address - Street 2:
Mailing Address - City:FREEMAN
Mailing Address - State:WV
Mailing Address - Zip Code:24724
Mailing Address - Country:US
Mailing Address - Phone:304-589-6399
Mailing Address - Fax:
Practice Address - Street 1:3997 BECKLEY RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-7660
Practice Address - Country:US
Practice Address - Phone:304-431-5499
Practice Address - Fax:304-431-3400
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV686363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCD7656OtherRR MC
WV0035334000Medicaid
WV3810000421Medicaid
WV001748653OtherBCBS
WV0022360001Medicaid
WV001748611OtherBCBS
WV511856Medicare Oscar/Certification
WVPA16281Medicare ID - Type Unspecified
WV0035334000Medicaid
WV5118601Medicare Oscar/Certification
WVCD7656OtherRR MC
WV5118561Medicare Oscar/Certification