MEDICARE: MS. TIFFANY MCKINNIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist	N081027390	OK

General Provider Information

NPI Number	:	1215870266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIFFANY MCKINNIS

Provider Business Mailing Address
First Line	:	2323 E COATSWORTH RD
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-7538
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 E COATSWORTH RD
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-7538
Country	:	US
Telephone Number	:	405-778-0773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “ MS. TIFFANY MCKINNIS ” Practice Location

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