Provider Demographics
NPI:1558516724
Name:CULPEPPER, TAWNYELL NIKKO (LISW)
Entity Type:Individual
Prefix:MRS
First Name:TAWNYELL
Middle Name:NIKKO
Last Name:CULPEPPER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 VA MEDICAL CENTER
Mailing Address - Street 2:SOCIAL WORK DEPARTMENT SUITE 122
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45428
Mailing Address - Country:US
Mailing Address - Phone:937-268-6511
Mailing Address - Fax:
Practice Address - Street 1:4100 VA MEDICAL CENTER
Practice Address - Street 2:SOCIAL WORK DEPARTMENT SUITE 122
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45428
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:937-262-5962
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0700948104100000X
OHI.12003111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker