Provider Demographics
NPI:1619186467
Name:PHIFER, JAMES FREDERICK (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FREDERICK
Last Name:PHIFER
Suffix:
Gender:M
Credentials:PHD
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 6456
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25772-6456
Mailing Address - Country:US
Mailing Address - Phone:304-525-3310
Mailing Address - Fax:304-525-3311
Practice Address - Street 1:440 BRECKENRIDGE LANE STE 124
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218
Practice Address - Country:US
Practice Address - Phone:502-491-9590
Practice Address - Fax:502-491-9592
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0830103G00000X, 103TB0200X, 103TC0700X
WV817103G00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
03810Medicare UPIN