Basic Information
Provider Information
NPI: 1184148777
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CURNUTTE
FirstName: TIFFANY
MiddleName: LEEANN
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2379
Address2:  
City: ASHLAND
State: KY
PostalCode: 411052379
CountryCode: US
TelephoneNumber: 6064086200
FaxNumber: 6064086612
Practice Location
Address1: 613 23RD ST STE G30
Address2:  
City: ASHLAND
State: KY
PostalCode: 411012881
CountryCode: US
TelephoneNumber: 6063270036
FaxNumber: 6063261159
Other Information
ProviderEnumerationDate: 07/26/2017
LastUpdateDate: 07/26/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X3011532KYY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home