Healthcare Provider Details

I. General information

NPI: 1942203872
Provider Name (Legal Business Name): TANYA S GOINS-HARMON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA S HARMON APRN

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 03/07/2023
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 S 7TH ST
MAYFIELD KY
42066-2337
US

IV. Provider business mailing address

318 S 7TH ST
MAYFIELD KY
42066-2337
US

V. Phone/Fax

Practice location:
  • Phone: 270-251-3223
  • Fax: 270-251-3220
Mailing address:
  • Phone: 270-251-3223
  • Fax: 270-251-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3002813
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3002813
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: