DERMATOLOGY OUTREACH, LLC (NPI# 1558678623) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558678623 |
| Entity Type | Organization |
| Organization Name | DERMATOLOGY OUTREACH, LLC |
| Practice Address |
111 State St. Bridgeport WV 26330 |
| Practice Telephone | 3048423341 |
| Practice Fax Number | 3048423441 |
| Mailing Telephone | 3048423341 |
| Mailing Fax Number | 3048423441 |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2013-05-17 |
| Authorized Official Name | MRS. KRISTI M LAFFERTY (OWNER) |
| Authorized Official Telephone | 3048423341 |
| Authorized Official Credential | CRNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
50679 | WV | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 2633814 | 05 | |
| WV | 7103093000 | 05 |
| Street Address |
111 STATE ST. |
| City | BRIDGEPORT |
| State | WV |
| Zip Code | 26330 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303036 | Gage Mackenzie Chichester | Nurse Anesthetist, Certified Registered | 2673 Medical Park Drive, Bridgeport, WV 26330 | 2020-10-12 |
| 1851914105 | Melany Langhurst | Social Worker | 64 Professional Place, Suite 102, Bridgeport, WV 26330 | 2020-05-21 |
| 1245704980 | Adam Christopher Stonestreet | Social Worker | Community Care of Bridgeport, 65 Professional Place, Bridgeport, WV 26330 | 2019-01-16 |
| 1588146658 | Bridgeport Physical Therapy Services, Inc. | Occupational Therapist | 25 Sweetbrier Lane, Suite 105, Bridgeport, WV 26330 | 2018-09-05 |
| 1275040685 | White Oaks Assisted Living | Assisted Living Facility | 140 Professional Place White Oaks, Bridgeport, WV 26330 | 2018-01-08 |
| 1275049371 | Regional Eye Associates, Inc | Ophthalmology | 220 Southview Drive, Bridgeport, WV 26330 | 2017-12-27 |
| 1528586187 | Savanna Tamia Brown | Social Worker | 65 Professinal Place Suites 101,102103, Bridgeport, WV 26330 | 2017-09-05 |
| 1184079642 | Karla Kay Rinehart | Social Worker | 27 Trovato St., Suite 103, Bridgeport, WV 26330 | 2016-05-03 |
| 1396176756 | Willo Group LLC | Pharmacy | 460 E. Main Street, Bridgeport, WV 26330 | 2013-12-10 |
| 1891031878 | Sherri Michelle Dobson | Occupational Therapy Assistant | 1000 Maplewood Dr, Bridgeport, WV 26330 | 2012-12-20 |
| Find all providers in zip 26330 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861915019 | Stephanie Jean Fluharty | Nurse Practitioner | 1511 Johnson Ave Ste 104, Bridgeport, WV 26330-1016 | 2017-07-19 |
| 1730601006 | Katherine Smith Carter | Nurse Practitioner | 68 Woodland Ave, Bridgeport, CT 06605-3457 | 2017-07-08 |
| 1285186148 | Helen Leahy | Nurse Practitioner | 439 Mill Hill Ave., Bridgeport, CT 06610 | 2016-10-26 |
| 1588119408 | Lisa M Finoia | Nurse Practitioner | 2800 Main St Fl 3, Bridgeport, CT 06606-4201 | 2016-08-20 |
| 1437568003 | Donte Jamal Newsom | Nurse Practitioner | 1370 Johnson Ave Ste 202, Bridgeport, WV 26330-1378 | 2014-08-08 |
| 1053675033 | Joanna R Fernandez | Nurse Practitioner | 500 Palisade Ave, Bridgeport, CT 06610-3458 | 2012-06-25 |
| 1659546109 | Christine Margaret Berte | Nurse Practitioner | 790 Fairfield Ave, Bridgeport, CT 06604-3701 | 2008-04-25 |
| 1043383508 | Susan Flanigan Bates | Nurse Practitioner | Mcmwtc Bldg 3005, Hc 83 Box 1, Bridgeport, CA 93517 | 2006-11-15 |
| 1629048418 | Renee Biehl | Nurse Practitioner | 761 Lindley St, Bridgeport, CT 06606-5043 | 2006-01-24 |
| 1073500773 | Erin Colleen Hawkins | Nurse Practitioner | 120 Medical Park Dr, Suite 300, Bridgeport, WV 26330-9012 | 2005-09-29 |
| Find all providers in BRIDGEPORT | ||||
| City | BRIDGEPORT |
| Zip Code | 26330 |
Please comment or provide details below to improve the information on DERMATOLOGY OUTREACH, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.