Provider Demographics
NPI:1184220360
Name:KINNEY, TAMMY D
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:D
Last Name:KINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45079 TOWNSHIP ROAD 413
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-9734
Mailing Address - Country:US
Mailing Address - Phone:740-291-7067
Mailing Address - Fax:
Practice Address - Street 1:45713 SR 541
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812
Practice Address - Country:US
Practice Address - Phone:740-610-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH486085107OtherOHIO DEPT. OF AGING REGION #9
OH1600842OtherDODD
OH3062484Medicaid