# TRI-STATE FAMILY MEDICINE & BEHAVIORAL HEALTH, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992231609
- **Authorized official:** CARMEN SIGLEY (APRN)
- **Authorized official phone:** (304) 777-9039

## Contact information

- **Practice address:** 17833 FAIR LADY WAY, DARNESTOWN, MD 20874-2289
- **Practice address phone:** (304) 777-9039
- **Mailing address:** 17833 FAIR LADY WAY, DARNESTOWN, MD 20874-2289
- **Mailing address phone:** (304) 777-9039

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | — | — |
| 363L00000X | Nurse Practitioner | R208314 | MD | Yes |
| 363LF0000X | Family Nurse Practitioner | 76278 | WV | — |

## Other

- **Enumeration date:** 05/02/2017
- **Last updated:** 02/02/2021