Provider Demographics
NPI:1033744065
Name:RAYMOND, TAWANA CHANELL (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TAWANA
Middle Name:CHANELL
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:TAWANA
Other - Middle Name:C
Other - Last Name:PITTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1636 POPPS FERRY RD STE 234
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2279
Mailing Address - Country:US
Mailing Address - Phone:228-641-2449
Mailing Address - Fax:
Practice Address - Street 1:1636 POPPS FERRY RD STE 234
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2279
Practice Address - Country:US
Practice Address - Phone:228-641-2449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-10
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0004562-C-NP363LF0000X, 363LP0808X
MS903892363LF0000X, 363LP0808X
TX1058787363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily