Provider Demographics
NPI:1578025540
Name:BURNS, TIFFANY FAYE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:FAYE
Last Name:BURNS
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 1:2725 MERCHANTS DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-1161
Mailing Address - Country:US
Mailing Address - Phone:573-691-7242
Mailing Address - Fax:888-977-2971
Practice Address - Street 1:2725 MERCHANTS DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-1161
Practice Address - Country:US
Practice Address - Phone:573-691-7242
Practice Address - Fax:888-977-2971
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program