Provider Demographics
NPI:1457052524
Name:FARR, ELIZABETH LYNN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LYNN
Last Name:FARR
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 1:720 1/2 INDIANA AVE APT D
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3371
Mailing Address - Country:US
Mailing Address - Phone:304-575-2244
Mailing Address - Fax:
Practice Address - Street 1:408 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2338
Practice Address - Country:US
Practice Address - Phone:304-575-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22-9146172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty