Healthcare Provider Details

I. General information

NPI: 1568659118
Provider Name (Legal Business Name): TIFFANY RENEE MCKIRNAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY R HEHMEYER PA-C

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 BELLEFONTAINE AVE STE 225
LIMA OH
45804-2896
US

IV. Provider business mailing address

1001 BELLEFONTAINE AVE
LIMA OH
45804-2800
US

V. Phone/Fax

Practice location:
  • Phone: 419-998-8244
  • Fax: 419-998-8243
Mailing address:
  • Phone: 419-998-4575
  • Fax: 419-998-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10000963A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085003049
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50003777
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: