Provider Demographics
NPI:1679149926
Name:CHIFFENS, ANDREA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:CHIFFENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ALEX LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2952
Mailing Address - Country:US
Mailing Address - Phone:304-734-2040
Mailing Address - Fax:304-734-2047
Practice Address - Street 1:303 OHIO AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2212
Practice Address - Country:US
Practice Address - Phone:681-205-8701
Practice Address - Fax:304-734-2047
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV924363A00000X
PAOA005799363A00000X
WV2486363A00000X
PAMA062571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant