Provider Demographics
NPI:1013320118
Name:DUTTON, TIFFANY D (CRNA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:D
Last Name:DUTTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:D
Other - Last Name:KIRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 MACCORKLE AVE SE
Mailing Address - Street 2:DEPT. OF SURGERY
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1227
Mailing Address - Country:US
Mailing Address - Phone:304-388-5503
Mailing Address - Fax:304-388-9852
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:DEPT. OF SURGERY
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1227
Practice Address - Country:US
Practice Address - Phone:304-388-5503
Practice Address - Fax:304-388-9852
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN70833-CRNA367500000X
OHAPRN.CRNA.16150367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106310Medicaid
WV3810028585Medicaid
OHH342700Medicare PIN