Provider Demographics
NPI:1629653852
Name:GARRETT, TIFFANY FAYE (MA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:FAYE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 ROBERT C BYRD DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2964
Mailing Address - Country:US
Mailing Address - Phone:681-587-5587
Mailing Address - Fax:
Practice Address - Street 1:3875 ROBERT C BYRD DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2964
Practice Address - Country:US
Practice Address - Phone:681-587-5587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator