| Tiffany Blackburn, Llc | |
|
991 S Kenmore Dr Evansville IN 47714-7514 | |
| (812) 491-7739 | |
| Not Available |
| Full Name | Tiffany Blackburn, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 991 S Kenmore Dr, Evansville, Indiana |
| Authorized Official Name and Position | Tiffany Miller (OWNER) |
| Authorized Official Contact | 8125507918 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tiffany Blackburn, Llc 991 S Kenmore Dr Evansville IN 47714-7514 Ph: () - | Tiffany Blackburn, Llc 991 S Kenmore Dr Evansville IN 47714-7514 Ph: (812) 491-7739 |
| NPI Number | 1922759026 |
|---|---|
| Provider Enumeration Date | 01/11/2022 |
| Last Update Date | 01/11/2022 |
| Certification Date | 01/11/2022 |
| Medicare PECOS PAC ID | 1456745926 |
|---|---|
| Medicare Enrollment ID | O20220225001609 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922759026 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tiffany Dawne Harper |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326704875 PECOS PAC ID: 2365836830 Enrollment ID: I20220225001694 |
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