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NPI Code Detail

MEDICARE: MRS. TIFFANY RENEE MCKINNEY AU.D.

MEDICARE: MRS. TIFFANY RENEE MCKINNEY AU.D.
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
1231H00000XAudiologist1116AAL
2237600000XAudiologist-Hearing Aid Fitter1116AAL
3231H00000XAudiologist80421TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770871329
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TIFFANY RENEE MCKINNEY AU.D.
Provider Business Mailing Address
First Line : 10700 N RODNEY PARHAM RD STE A7
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72212-4159
Country : US
Telephone Number : 501-225-6060
Fax Number : 501-225-6450
Provider Business Practice Location Address
First Line : 912 WALNUT HILL DR
Second Line :
City : LONGVIEW
State : TX
Zip : 75605-5052
Country : US
Telephone Number : 903-291-6300
Fax Number : 903-291-6305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2011
Last Update Date : 04/20/2022

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