MEDICARE: MS. TANYA K BINFORD PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN RN095667	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	242941	NC
3	363L00000X	Nurse Practitioner	242941	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	839717	OTHER	AZ	AZ AHCCCS

General Provider Information

NPI Number	:	1982796264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TANYA K BINFORD PMHNP

Provider Business Mailing Address
First Line	:	PO BOX 538622
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-8622
Country	:	US
Telephone Number	:	910-742-9243
Fax Number	:	888-746-1787

Provider Business Practice Location Address
First Line	:	1213 CULBRETH DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28405-3639
Country	:	US
Telephone Number	:	910-742-9243
Fax Number	:	888-746-1787

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	09/15/2015

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