Provider Demographics
NPI:1770669996
Name:MCKINNIE-COBB, TANYA LAFAYE (BA)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LAFAYE
Last Name:MCKINNIE-COBB
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:TANYA
Other - Middle Name:LAFAYE
Other - Last Name:MCKINNIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:2150 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-6662
Mailing Address - Country:US
Mailing Address - Phone:901-353-5440
Mailing Address - Fax:901-353-5464
Practice Address - Street 1:2150 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6662
Practice Address - Country:US
Practice Address - Phone:901-353-5440
Practice Address - Fax:901-353-5464
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator