Individual
TIFFANY DUMONT KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 PENNSYLVANIA AVE, CHARLESTON, WV 25302-3351
(304) 388-2470
Mailing address
2138 PRESIDENTIAL DR, CHARLESTON, WV 25314
(304) 561-5967
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
42872
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0067551000
—
WV
01
—
27-3419445
TAX ID
WV
Enumeration date
07/21/2006
Last updated
06/09/2015
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