1942203872 NPI number — MRS. TANYA S GOINS-HARMON APRN

Table of content: MRS. TANYA S GOINS-HARMON APRN (NPI 1942203872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942203872 NPI number — MRS. TANYA S GOINS-HARMON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOINS-HARMON
Provider First Name:
TANYA
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARMON
Provider Other First Name:
TANYA
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942203872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
318 S 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYFIELD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42066-2337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-251-3223
Provider Business Mailing Address Fax Number:
270-251-3220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 S 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42066-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-251-3223
Provider Business Practice Location Address Fax Number:
270-251-3220
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  3002813 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 3002813 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 597243 . This is a "WELLCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 363LF0000X . This is a "TAXONOMY CODE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 78028131 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3002813 . This is a "NEW LIC # 01-10-11" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000612626 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 363L00000X . This is a "TAXONOMY CODE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100090880 . This is a "MEDICAID ARNP GRP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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