Provider Demographics
NPI:1780123562
Name:GRIFFITH, CAROL LYNNE (RN, AG-ACNP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LYNNE
Last Name:GRIFFITH
Suffix:
Gender:
Credentials:RN, AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 GLENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3202
Mailing Address - Country:US
Mailing Address - Phone:937-239-8453
Mailing Address - Fax:
Practice Address - Street 1:61 DARST RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3407
Practice Address - Country:US
Practice Address - Phone:937-424-3589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.274046163W00000X
OHAPRN.CNP.023032363LG0600X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology