Provider Demographics
NPI:1427169408
Name:LAFFERTY, KRISTI M (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:M
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106B CAMBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-2812
Mailing Address - Country:US
Mailing Address - Phone:304-842-3341
Mailing Address - Fax:304-842-2339
Practice Address - Street 1:417 GRAND PARK DR STE 106
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-4049
Practice Address - Country:US
Practice Address - Phone:304-842-3341
Practice Address - Fax:304-842-2339
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV50679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7103093000Medicaid
OH2633814Medicaid
WVP62606Medicare UPIN
OH2633814Medicaid
WVLANP10712Medicare PIN
WVP00301019Medicare PIN