DERMATOLOGY OUTREACH LLC NPI 1558678623

NPI Information

NPI: 1558678623
Provider Name: DERMATOLOGY OUTREACH, LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
111 STATE ST.
BRIDGEPORT, WV
ZIP 26330
Phone: (304) 842-3341
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DERMATOLOGY OUTREACH, LLC is a family nurse practitioner in Bridgeport, WV. DERMATOLOGY OUTREACH, LLC NPI is 1558678623. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

111 STATE ST.
BRIDGEPORT, WV
ZIP 26330
Phone: (304) 842-3341
Fax: (304) 842-3441

The provider's authorized official is Kristi M Lafferty .
The authorized official title is Owner and has the following contact phone number (304) 842-3341.

The enumeration date for this NPI number is 9/9/2010 and was last updated on 5/17/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	50679	WEST VIRGINIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	7103093000	MEDICAID	WEST VIRGINIA
2	P62606	MEDICARE UPIN
3	LANP10712	MEDICARE PIN	WEST VIRGINIA
4	P62606	MEDICARE UPIN	WEST VIRGINIA
5	2633814	MEDICAID	OHIO
6	LANP21911	MEDICARE PIN	OHIO
7	NP10713	MEDICARE PIN	WEST VIRGINIA
8	9391271	MEDICARE PIN	WEST VIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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