Organization
DERMATOLOGY OUTREACH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTI M LAFFERTY CRNP (OWNER)
(304) 842-3341
Entity
Organization
Contact information
Practice address
111 STATE ST., BRIDGEPORT, WV 26330
(304) 842-3341
(304) 842-3441
Mailing address
111 STATE ST., BRIDGEPORT, WV 26330
(304) 842-3341
(304) 842-3441
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
50679
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2633814
—
OH
05
—
7103093000
—
WV
Enumeration date
09/09/2010
Last updated
05/17/2013
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