Provider Demographics
NPI:1770239139
Name:RICHARDSON, TIFFANY LEE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
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 95
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:WV
Mailing Address - Zip Code:24935-0095
Mailing Address - Country:US
Mailing Address - Phone:681-220-4470
Mailing Address - Fax:
Practice Address - Street 1:128 RED ROCK DR
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:WV
Practice Address - Zip Code:24935-2404
Practice Address - Country:US
Practice Address - Phone:681-220-4470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant