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NPI Code Detail

MEDICARE: TIFFANY N BYNUM

MEDICARE: TIFFANY N BYNUM
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
1163W00000XRegistered Nurse785152TX
2363LF0000XFamily Nurse Practitioner1002612TX

General Provider Information

NPI Number : 1376006403
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY N BYNUM
Provider Business Mailing Address
First Line : 4705 BRIARWOOD AVENUE
Second Line :
City : MIDLAND
State : TX
Zip : 79707-2639
Country : US
Telephone Number : 432-505-4145
Fax Number : 833-941-0864
Provider Business Practice Location Address
First Line : 4705 BRIARWOOD AVENUE
Second Line :
City : MIDLAND
State : TX
Zip : 79707-2639
Country : US
Telephone Number : 432-505-4145
Fax Number : 833-941-0864
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2019
Last Update Date : 11/15/2024

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Directions to “ TIFFANY N BYNUM ” Practice Location

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