Provider Demographics
NPI:1295799385
Name:RIFFE, MICHELLE L (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:L
Last Name:RIFFE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:L RIFFE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:401 6TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONTGOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:25136-2116
Mailing Address - Country:US
Mailing Address - Phone:304-442-8516
Mailing Address - Fax:304-442-0212
Practice Address - Street 1:401 6TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-2116
Practice Address - Country:US
Practice Address - Phone:304-442-8516
Practice Address - Fax:304-442-0212
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV689363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1802460000Medicaid