MEDICARE: TIFFANY R LOPEZ CPS

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	172V00000X	Community Health Worker		MO
2	175T00000X	Peer Specialist		MO

General Provider Information

NPI Number	:	1770418907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY R LOPEZ CPS

Provider Business Mailing Address
First Line	:	101 W COATES ST
Second Line	:
City	:	MOBERLY
State	:	MO
Zip	:	65270-1521
Country	:	US
Telephone Number	:	660-651-5065
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W COATES ST
Second Line	:
City	:	MOBERLY
State	:	MO
Zip	:	65270-1521
Country	:	US
Telephone Number	:	660-263-7173
Fax Number	:

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

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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Directions to “ TIFFANY R LOPEZ CPS” Practice Location

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