Provider Demographics
NPI:1568659118
Name:MCKIRNAN, TIFFANY RENEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:RENEE
Last Name:MCKIRNAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:TIFFANY
Other - Middle Name:R
Other - Last Name:HEHMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:1005 BELLEFONTAINE AVE STE 225
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2896
Practice Address - Country:US
Practice Address - Phone:419-998-8244
Practice Address - Fax:419-998-8243
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000963A363AS0400X
IL085003049363AS0400X
OH50003777363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618941OtherBLUECROSS/BLUESHIELD
IN408430ZMedicare PIN
ILK47927Medicare PIN
ILK47928Medicare PIN
IL01618941OtherBLUECROSS/BLUESHIELD