MEDICARE: TIFFANY KAVANAUGH

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	163WC0400X	Case Management Registered Nurse	00125836	WA

General Provider Information

NPI Number	:	1245120831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY KAVANAUGH

Provider Business Mailing Address
First Line	:	6418 E 18TH AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99212-0102
Country	:	US
Telephone Number	:	509-499-2182
Fax Number	:

Provider Business Practice Location Address
First Line	:	6418 E 18TH AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99212-0102
Country	:	US
Telephone Number	:	509-499-2182
Fax Number	:

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

Provider Enumeration Date	:	07/07/2025
Last Update Date	:	07/07/2025

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Directions to “ TIFFANY KAVANAUGH ” Practice Location

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