Provider Demographics
NPI:1578107132
Name:MEHAFFEY, TAMIKI M
Entity Type:Individual
Prefix:
First Name:TAMIKI
Middle Name:M
Last Name:MEHAFFEY
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 1:517 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEWELL
Mailing Address - State:WV
Mailing Address - Zip Code:26050-1113
Mailing Address - Country:US
Mailing Address - Phone:412-951-6871
Mailing Address - Fax:
Practice Address - Street 1:560 STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:BURGETTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15021-8539
Practice Address - Country:US
Practice Address - Phone:724-947-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104818363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner