Healthcare Provider Details

I. General information

NPI: 1548430218
Provider Name (Legal Business Name): TINA RENEE VERMILLION M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2008
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S MAIN ST
MCPHERSON KS
67460-4832
US

IV. Provider business mailing address

320 S MAIN ST
MCPHERSON KS
67460-4832
US

V. Phone/Fax

Practice location:
  • Phone: 620-504-6313
  • Fax:
Mailing address:
  • Phone: 620-504-6313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2307
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2012035405
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: