Individual
TINA ALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1277 STONEY RIDGE RD, BLUEFIELD, WV 24701-4266
(304) 920-5107
(304) 425-7111
Mailing address
355 BLUEFIELD AVE, BLUEFIELD, WV 24701-2883
(304) 425-7111
(304) 425-1138
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
1568796027
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55-6025355
—
WV
Enumeration date
10/06/2020
Last updated
12/09/2020
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