Provider Demographics
NPI:1699275719
Name:RIFFE, KATLYNN TAYLOR
Entity type:Individual
Prefix:
First Name:KATLYNN
Middle Name:TAYLOR
Last Name:RIFFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4014
Mailing Address - Country:US
Mailing Address - Phone:304-888-0681
Mailing Address - Fax:
Practice Address - Street 1:1712 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4014
Practice Address - Country:US
Practice Address - Phone:304-888-0681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care