Healthcare Provider Details

I. General information

NPI: 1780329110
Provider Name (Legal Business Name): DANIEL JAY TINNEY APRN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CLINIC DR
PARIS KY
40361-2161
US

IV. Provider business mailing address

22 CLINIC DR
PARIS KY
40361-2161
US

V. Phone/Fax

Practice location:
  • Phone: 859-987-0074
  • Fax:
Mailing address:
  • Phone: 859-987-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3017613
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: