Healthcare Provider Details

I. General information

NPI: 1992428262
Provider Name (Legal Business Name): TATTIANA LYNETTE INYARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TATTIANA LYNETTE SERRANO

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 E WICHITA AVE
RUSSELL KS
67665-2444
US

IV. Provider business mailing address

3510 SW CLARE AVE
TOPEKA KS
66611-2329
US

V. Phone/Fax

Practice location:
  • Phone: 785-377-4744
  • Fax:
Mailing address:
  • Phone: 785-279-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: