Provider Demographics
NPI:1518446111
Name:COFFEY, TANYA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:COFFEY
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 1:185 WOODCLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2204 ST CHARLES ST
Practice Address - Street 2:
Practice Address - City:LECOMPTE
Practice Address - State:LA
Practice Address - Zip Code:71346-5490
Practice Address - Country:US
Practice Address - Phone:318-406-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator